Document ypVr1gYzxj7y6j012wrmoem7E

FILE NAME State of the Art Literature SAL DATE 1955 DOC SAL060 DOCUMENT DESCRIPTION The Dust Diseases in Great Britain VOLUME 12 1955 PUBLISHERS AMERICAN MEDICAL MEDICAL ASSOCIATION CHICAGO 10 U.S. GOVERNMENT PRINTING OFFICE A. M. Archives HEALTH M. A. chives of LATOLOGY eee ,> , oth on at your nformation ATION Street Deal it a Voseme 12 TABLE -_ . _ OF CONTENTS JULY 1955 - tote to ee ee Number 1 ORIGINAL ARTICLES Papers Read at the Mcintyre Conterence on Occupational Prologue Saranac Lake N. Y. Feb. 7 8 and 9 1955 Chest Discose Cargy P. McCord M.D. Ann Arbor Mich PAGE cece eeeccceccc.. | af. The Objectives and Achievements of the Mcintyre Research Foundation Francis B. Trudeau M.D. Saranac Lake N. ecccee cece. Sen 2 W.W. 35 The Contribution of the Saranac Laboratory to Research on Chest Diseases A. D. For M.E. Toronto Canada e e ee eee tteeiecereteeeencres. 4 Comparative Vascular Pathology of Occupational Chest Diseases W. Schepers M.D. D.Sc. Saranae Lake N. cece seeesees 7 Occupational Pulmonary The Value of Lung Biopsy in the Diagnosis of H. S. Pan Ordstrand M.D Donald B. Diseases .; : and John B. Hazard M.D. Effler Effler Cleveland Cleveland M.D Lawrence J. McCormack M.D. . ee eect eee eteneeee ieee, + 26 il Occupational Chest Diseases in Gold Miners . G. IV H. Schepers M.D. D.Sc. Saranac Lake Y. ..,.., en 33 the Accomplishments in [ Epidemiologic Study of Silicosis in the United States .; H. Doyle B.S Victoria M. Trasko A.B M. M.D. Washington D. Gujafer D.Sc. and E. Miller ... te TTT eae eee steer teen teseesrncas soon 48 Silicosis in Canada Can ceceada N. F. Parkinson M.E. Toronto cetecceeseetecceece... 56 CommenStilaircyosiosn PRreofbelreemnciens ObnytaNr.ioF. Parkinson Concerning the Andrew R. Riddell M.B. D.P.H. Toronto Canada ...... 63 Tolc Pneumoconiosis M.D. Irving Irving Tabershaw M.D Morris Kleinfeld New Jacqueline Messite M.D. and New York bas eteeseecnees Irving R. Tabershaw M.D. EE T 66 Pneumoconiosis on the Kolar Gold Field South India Geofrey E. Firench ... M.D. F.R.C.P. C Oakville Ont Canada ..... 73 The Dust Diseases in Great Britain . A. McLaughlin M.D. F.R.C.P. London 83 Clearance of Radioactive Dust from the Human Lung Roy E. Albert M.D. Washington D.C. and Laterence C. Irnett M.D. M.D. Brooklyn 99 REGULAR DEPARTMENTS .. PT eee ee ee eee eases . eee, eu Oe Tae DOE AREsp ale CP 7) or asat Sy we aor. is Tay Pe RA rePE a Meteo DISNEY ETL h eteSeth AMA Arch Inde A Health 12:83 1955 : am THro A regnation of e . ewe * Wentworth a Pathological mosis J. Fac and King en Sericite and 237 1934 of Lobar Proc Soc oe Be hel fe te wl Does, + cape: ple + or rn The Dust Diseases in A. I. G. McLAUGHLIN M.D. F.R.C.P. London tres BASLE MSs RMON A The story of dust diseases in Great Britain goes back a long way E. L. Collis in his classical Milroy Lectures of 1915. quoted Herbert Spencer as saying that the starting point of human progress was the localization of industries There was such a localization in prehistoric factories for the making of flint implements at Grime's Graves near Brandon in Suffolk where the flint knappers still use tools like the horn picks of their prehis- toric ancestors In 1914. Collis showed that these workers have a high mortality from silicosis He said that is probable that the starting point of human progress was associated with at least one form of pneumoconiosis has been long known that the dust of flint which is nearly pure SiOg is dangerous health Over 200 years ago Thomas Ben- son of Newcastle under Lyme was granted a patent for grinding flints by a wet method At that time it was said that a man who ground the flints dry could not live longer than two years Our greatest localization of industries took place during the Industrial Revolution and this was really the starting point of our intensive knowledge about the effects of dust on the lung The first notable contribution was that of Pearson 1813 who after many autopsies decided that the black pigment in the bron- chial nodes and the lungs was due to the in- Palation of small particles resulting from the burning of coal wood and other inflammable materials The German pathologists on the other hand thought that the pigment cane inside the body Meiklejohn 1951 has described the hitherto known and re- a Recorded for for publication publication April April 7 11995555 M. Medical Inspector of Factories Britain__ Great Britain__ Britain__ markable contributions of the Scottish physi- cians of the 1800's on the connection between disease of the lungs and coal dust ; he also tells how the incidence of anthracosis diminished with improved ventilation of the mines The Scottish physicians decided that simple coal dust was comparatively harmless and that stone dust was the really noxious factor Charles Turner Thackrah a physician in Leeds played a major part in the study of occupational diseases including the dust discases in Great Britain In his book The Effects of Arts Trades and Professions the second edition of which was published in 1832 he crystallized the idea that the inhalation of large quantities of dusts of any kind can damage the lungs but that some dusts are more harmful than others His conclusions were based on hand observations of workers in hospitals in their homes and in the factories Two other great Englishmen in the history of pneumoconiosis about the middle of the 19th century were T. B. Peacock and E. Greenhow Peacock first established miners disease as an entity and distinguished it clinically from pulmonary tuberculosis before little was known about bacteriology and noth- ing about rays Greenhow carried out the first large field investigations into the dusty industries of England and Wales including the heavy industries the potteries coal copper and lead mining and even agriculture In the Transactions of the Pathological Society of London 1860-1866 there are to be found excellent descriptions by both of these physicians of th^ disease which was later to be called silicosis by Visconti in 1870. They even iound the dust ai free silica in the hangs and examined it under polarized light For long time after this excellent work nothing much was done about the dinst diseases but about the beginning of the 20th 3 we aides ok, ' x tea hyaap 4y wef ab y ryaa oea2e avt . t leont Me we ae car i one tore ay de cee Ise mu, Sa A. M. A. ARCHIVEARCHSIVES OF INDUSTRIAL HEALTH century new interest began to be taken in the problem not only in England but also in oflier parts of the world About the same time the tempo of life in general began to in- crease and there was an urge for increased speed of production urge which has gradnally gathered momentum With the replacement of hand labor by the machine dusty processes have become more dusty and methods of dust control have lagged behind output The result has been a remarkable increase of the incidence of the dust diseases A noteworthy contribution in 1892 was Arlidge's book on the occupational diseases which was only the second to be published in England In 1904 J. S. Haldane and his colleagues ascribed the high mortality among tin miners the inhalation of rock dust A little earlier dust phthisis among slate workers was shown to be related to the dust of slate particularly when it had a high quartz content E. Collis 1915 pinpointed the dust of free silica as the main cause of most of the dust diseases He also drew attention to the role that dust inhalation plays in determining the mortality from lung diseases experienced the general population Long ago he showed the influence of air pollution on the mortality from lung diseases in general Though Cailis did this work 40 years ago lie is always date He had and still has an uncanny knack of seeing to the heart of any problem Just now in England there is controversy about chronic bronchitis and emphysema and whether they can be held to be caused by the inhalation of dust It true that the incidence of chronic bronchitis and emphysema high among the general population and the possible causes are legion It difficult to decide in Arlidge's words how unich of the malady is made or trade- made But Collis showed years ago an which irritates the lung parenchyma can also irritate the brouchial mucous membrane At present there is one industrial pulmonary disease of which the diagnosis is made largely ou the presence of chronic bronchitis and emphysema and that is byssinosis oe In the last 50 years in Great Britain as elsewhere there has been intensive research into all aspects of the dust diseases such as causation pathology incidence in various industries and prevention For the first 25 years or so much of the impetus came from H. M. Medical Inspectors of Factories and prominent in the study of the chest diseases were Collis Middleton and Merewether It might be said that they played almost a lone hand with meager facilities for investigation However they were helped greatly by hospital physicians general practitioners radiologists and pathologists notably Hall Robertshaw Kettle Gloyne and Cooke During this period much attention was paid to silicosis and it with tuberculosis was established as being the cause of disability and death in most of the industries where there is exposure to the dust of free silica Pari passu regulations laying down control measures were issued by the Factory Department for most of ue the major industries Notable contributions an e were Collis's work already mentioned on the role of free silica and Middleton's field in- vestigation with E. L. Macklin into the grinding industry in 1923. In the late 20's series of brilliant observations by Cooke Glovne Burton Wood Stuart McDonald and we t M. J. Stewart on the clinical radiological and pathological features of a new disease mn which Cooke named asbestosis led to field in- enn vestigations by Merewether and Price 1930 TO These firmly established that the dust of as- Be bestos was dangerous to health and it was ate the first time that the dust of combined silica 2 Ht as opposed to free silica was found to damage the lungs The condition as Legge points out TNO was first seen in 1906 by Murray at Charing OR Cross Hospital but little or no notice of it OE was taken at that time LEP An important landmark was the passing of NT the Workmen's Compensation Silicosis Act of which came into force in 1919 For the first time compensation for disable- am ment or death was given in respect ni au ^fin- ete dustrial pulmonary disease The Act Rat pro- me vided initud and periodical medical examina- tion z^/l workers in the refractories industry Rems 6 one ioe Ree Yrs iSRobneey raroateiamnnse ne Se AE ae i. me fy a + ee 4. vi] toa VAL HEALTH $ DUST DISEASES IN GREAT BRITAIN o~ tain as Fesearch Fesearch es such as various in- { or the first 25 : Its came from Factories and : chest diseases : erewether It : almost a lone j investigation catly by hospi- oners radiolo- 7 Hall Robert- : e During this t ack to silicosis ; stablished as . death in most 7 ~~ to exposure > < regulations res were is- F : for most of t coino trnibeud tiontshe j | m's field in- t . 20's i Cooke OE Cooke 3 cDonald and radiological disease new i led to field in- Price 1930 and suspension from the industry on a diag nosis of simple silicosis as well as silicosis with tuberculosis The medical officers re- sponsible for the examinations were the Tu- berculosis Officers of the Local Authority administering sanatorium benefit under the National Health Insurance Act The scheme was revised in 1925. and again in 1931 to provide for examinations by a medical board This was the beginning of the whole Silicosis and Asbestosis Medical Board under its first and only Chief Medical Officer L. Sutherland with silicosis in 1935 hematite ore miners were included and in 1939 slate miners Workers with asbestosis were first compensated in 1931 compensation for byssinosis was introduced in 1941 and was dealt with by a specially constituted board Pneumoconiosis as opposed to classical silicosis in coal miners was brought under the compensa- tion schemes in 1943 and in coal trinumers in 1946. The Various Industries Scheme was again amended in 1946 to include molders of iron castings who used siliceous parting pow- A close association began between the Medical Inspectorate of Factories and the Silicosis and Asbestosis Medical Board both groups working under the Home Office In general the Medical Inspectorate made the field investigations which established the risk of silicosis or asbestosis in an industry or process and which led to the establishment of the various compensation schemes But the members of the Board | stationed at Sheffield ders and also blasters of any type of metal castings to free them from adherent sand even if the blasting abrasive was nonsiliceous The National Insurance Industrial Injuries Act was passed in 1946 and altered the whole _ basis of compensation in that it became the re- sponsibility of the Government but with con- tributions from employers and workers Ber- yllium poisoning 1949. In 1954 all steel and became foundry compensable in workers iron Manchester Manchester Manchester Stoke on Trent out field investigations Cardiff and Cardif vari- sandstone ous industries such Sutherland and Bryson 1929 granite Sutherland and Bryson 1929 and potteries Meiklejohn 1949 But perhaps the most significant re- sult the formation of the Board was that there was begun a systematic and valuable collection of case histories with ray films nonferrous became entitled Act to pensation under the Industrial Injuries Act A fuller account of the development of com- recently 9 pensation in Great Britain written by Meiklejohn has been 1954 The Silicosis and Asbestosis Medical Board was trans- ferred from the Home Office in 1946 to the Ministry of National Insurance later com- Ministry Pensions bined with the of Board was divided into a series of The Pneu- he dust of as11. and it was mbined silica findings together with occupational details and post- mortem At first the Board was limited to few in- the Board didwork moconiosis Panels hut they the same way as there is now no Chief Medical in much except that Officer nd damage dustries but gradually its scope has increased and | and more ge points | more dusty industries have i y at Charing come under examination Workers in the re- in notice of it | fractories industry first came under a com- pensation scheme 1925 metal grinders in he passing of 1927 and sandstone workers in the Various Industries Scheme Silicosis : ree in 1919 processes of mining quarrying 1929. In 1928 included the drilling and ; for disable- ect of an in- Blasting in silica rock the crushing and grind ing of siliceous materials and also isolated he Act proal examina ries industry ; processes in steel foundries not iron foun- ' dries and metal works in potteries and in tin mines In 1934 the Various Industries Scheme was amended to include coal miners The various compensation schemes men- tioned above reflect the evolution of the study of the industrial lung diseases in Great Britain There are comparable legal enactments and regulations designed to control the risks in each industry but they are tou numerous to mention in detail To flash back little in 1936 Middleton in his Milroy Lectures reviewed the position of the dust diseases in Great Britain He covered all the dusty trades including coal mining but at that time only cases of silicosis in costi miners were recognized as being eligi ble for competes Most of the miners F 35 i Mad aninaens cn : f be ; aes P FS 7: Li: z M. ^ ARCHI OF INDUSTRIAL HEALTH | DUS such as hardheaders drifters or rippers had been exposed to stone dust but Middleton also showed that there was ahigh incidence of a lung disease among coal miners particularly in South Wales which was not classical sili- cosis Much of his evidence was drawn from the findings of the Silicosis and Asbestosis Medical Board Following his paper there began a series of intensive investigations by the Medical Research Council into the health risks of coal mining which covered all as- pects such as clinical radiographic and en- vironmental Medical Research Council Spe- cial Reports I 1943 II 1943 and III 1945 The important fact emerging from this work was that coal dust by itself could and pneumoconiosis followed ccaannssee pneumoconiosis and thithsis was was followed as previously mentioned by the extension of compensation to coal miners and coal trim- mers In 1945 the Pneumoconiosis Research ; 3. Stone quarrying crushing and dressing This group includes workers with sandstone millstone gritstone slate granite and other igneous rocks The risk varies with t the yp amount of free silica in the rock and of course with the protective measures arlopted Recently some limestone quarrymen have contracted silicosis but the limestone con- tained a fairly high proportion of free silica In this group could be included rock tunnel- $ ers in whom the onset of silicosis may be very rapid As regards slate workers a biltable maker has recently received com- pensation for silicosis [- | | DEATHS FROM SI1L9I3C0O-S1I9S51IN METAL GRINDERS H 5 19 posi gan sive sand the Reg oi si lati cie oi use con met 6 toli abr or losi Unit of the Medical Research Council was set up in Cardit~ and an impressive body of work has emerged on various aspects of coal miners pneumoconiosis This work is well known and J propose therefore to limit my remain- ing observations mainly to the dust . diseases resulting from work in places which come under the Factories Acts with only inciden- tal references references to ccooaal l mining mining one | 192 WOL Tt con PY and "4 ank to { People . . bec an an { 1940 1945 1948 1950 1945 tin SILICOSIS Silicosis has disability disability disability in the been found to be a cause of in- fol owing following following broad groups of in- dustries as well as in cual mining and other forms of mining such as tin hematite copper bariteansd fire clay This in- 1. Refractories industry This group in- cludes the making of silica bricks furnace dismantling and rebuilding and retort setting repairing and and repairing Workers in this industry 2. industry PotteryPottery Workers in this group of in engaged have been the in manufacture manufacture of both earthenware and cchhinia na wiwithth tthheeiir r vvaarriioou us s polishers flint polishers snlulivisions polishers and snlulivisions and flint millers and as flint alumina of The substitution substitution of ground flint by alumina for the placing placing biscuit of biscuit in ware ware ware has has rreessulutledted in dimmuunion of deaths from silicosis among workers in that process Fig Chart showing diminishing numbers of Sui deaths among metal grinders during the period } Sui 1930-1951 inclusive ma ma 4. Metal grinding The silicosis risk in the grinding of metals has greatly diminished owing to the replacement of the sandstone grinding grinding with artificial wheels grinding wheels with artificial ones composed of Carborundum alumina or emery Apart nev i fol ggriri and for | from the lower toxicity of the dusts from Lu Lu these substances the wheels are much harder 117 sandstone and dust than sandstone grinders and lelsesss dust iiss crceraetaedtecd reated But aas s the grinders of castings castings iron steel and non- 7 ferrous still silicosis risk ferrous are exposed to silicosis risk on 501 of of on account of the presence of burned sand on the castings castings castings The The grinders daninishing daninishing number is shown 113 of lov deaths among grinders is shown in the chart among 157 Fig 1 1 Dog A. Unpublished data tr 86 the 50 the 50 the 7 etee 1 ~ HEALTH DUST DISEASES IN GREAT BRITAIN ng and dressing eae kers with sandstone AS granite and other met 4 5. Sandblasting This job as Merewether 1936 showed had a high silicosis risk The position has altered fact that the dust from the pneumatic hammer is not controlled The main pathological lesion Articles sk varies with the materially after sand began to be replaced by other nonsiliceous abra- was classical silicosis with or without tuber- i the rock and of sives such as steel shot and since culosis Among iron fettlers the risk was not e measures adopted sand as an abrasive the use of so great as among steel fettlers and the main * quarrymen have Oe was prohibited in 1949 by the Blasting of Castings and other pathological lesion found was mixed dust the limestone con- rtion of free silica em Regulations . The process of wet sandblasting pneumoconiosis though classical silicosis did cluded rock tunnel- of ships hulls does not come under the Regu- occur Steel molders were less affected by dis- Ser of silicosis be lations because legally a ship is not an arti- ease and disability than iron molders though may late workers a bil- e e cle but it is thought that there is also a risk of silicosis in the statistically the incidence of ray abnormal- ities was greater steel ently received com- job Sandblasting is still among workers More None used in the open air on works of engineering deaths occurred among iron molders and this construction e g in order to prepare large fact appeared to be related to the use of me eli ae neey ce metal surfaces for the application of paint siliceous parting powders The use of siliceous 'METAL GRINDERS eM 6. Manufacture of abrasive soap Middle- parting powders has now been prohibited by 751 | oad ton showed in 1936 that the manufacture of the Foundries Parting Materials Regula- e abrasive soaps carried with it a risk of acute tions 1950. Silicosis still occurs among shot or subacute silicosis accompanied by tubercu- | losis There was a disastrous experience at blasters of both iron and steel castings but the risk is controlled by ventilation and per- one factory in London between 1921 and sonal protective devices and the numbers of | en 1928 when there were 13 deaths among SI cases and deaths in contrast with the experi- q workers This experience led to rigorous dust ence among steel fettlers are not increasing NT4 control in the processes but between 1941 Other categories of iron and steel foundry and 1952 there were nine deaths from silicosis workers are subject to much less risk than among this type of worker It is not possible the above groups of workers New and strin- to state the incidence of disease and disability because there is a rapid turnover of labor mostly young women in the job Silica flour is still being used as an abrasive though gent regulations Iron and Steel Foundry Regulations were issued in 1953. They require strict dust control in the dusty proc- esses minishing numbers of rs during the period he silicosis risk in greatly diminished of the sandstone dicial ones composed or emery Apart of the dusts from els are unich harder dust is created But efforts are being made to find a less harmful substitute which will be acceptable to the manufacturers and the users There were no new cases of silicosis in this trade in 1953 7. Foundry industry The iron and steel foundry industry has been investigated in great detail during the past 10 years or so and the results were published in 1950 in book form by McLaughlin and others Industrial Lung Diseases of Iron and Steel Foundry Workers Pathological studies of 64 cases The question of pneumoconiosis among nonferrous foundry workers is now being ex- amined in detail Isolated cases of silicosis and mixed dust pneumoconiosis have occurred among both casters and dressers of nonferrous metals but an extensive survey has not yet been carried out Harding Harding and McLaughlin have described the pathological clinical ra- diological and environmental details of six fatal cases ron steel and non- as well as clinical and ray examinations of Table 1 shows the number of new cases of a silicosis risk on see burned sand on ishing shown number of in the chart Teme some 3000 workers showed that there was a varying risk of silicosis and mixed dust premoconiosis to which reference is made be- low in the various categories of foundry workers Steel fettlers tiressers or castings cleaners had severe risk largely owing to the pneumoconiosis e silicosis and mixed dust pneumoconiosistpneumocniosit in ioandry workers diag- moser by the Pneumoconiosis Panels in 1953 These figures can be regarded as an under- statement the real position More than hali ~ Flude li be published and and McLaughlin A. 1. 1. .: $ 7 Sercareeres 20 ENG) cat tbe far; ONS t Be 7 aya M. A. ARCHIVES OF INDUSTRIAL HEALTH Table New Cases of Pneumoconiosis Foundries Deempation Iron twoldink . fe eeeee eae Sentence cane eee Troy dressing .. veseeee Iron foundry knockout . molding Steel taeeeenes OMe e ener ence cece eree Steel dressing cece ee . eccacesccecs 6. Nonferrous dressing de eeeeeee Welders shops and oo, burners in enstings cleaning General foundry work Total 57 21 q + 13 2 20 a Total 192 Twenty of these workers to runi dust for varying periods had also been exposed of the cases in iron molders came from one area where there had been an ray survey of three foundries If more iron foundries had been similarly surveyed more cases would have been found In certain steel foundries the dressers chippers or castings cleaners are rayed each year but a complete picture of the true position will not be obtained until all workers undergo periodical medical examination This statement also applies to other dusty industries In Table 2 details are given of fatal cases of silicosis and asbestosis investigated fully by the Medical Inspectorate of Factories between 1930 and 1953. The average ages at death and the length of employment in the dusty industries are also given is seen that as regards silicosis the manufacture of scouring powders and sandblasting were the most dangerous industries with the lowest average age at death and the shortest average period of employment Another interesting point is that tuberculosis occurred in about half of the cases of silicosis whereas it was found in only about fifths of the cases of asbestosis The average age at death and the length of exposure in the cases of as- bestosis were much lower than in the silicotic group as a whole but more on the level of sandblasters and makers of scouring powders The connection between asbestosis and cancer of the lung is becoming clearer and in one series of 100 autopsies on asbestosis cases there were 25 cases of cancer of the lung Wyers 1949 has pointed out that the ray 756282439S 756282439S gri ^ ei 756282439S per 756282439S 756282439S 8 Tamun Fatal Cases of Silicosis and Asbestosis Investigated by Factory Department 1930-1953 Silicosis Cultery Deaths No. 750 301 Sandstone Silirosis Silleosis Coc ceec ceea ees Oe CO rN ere nee eet e ence eer aee . with tuberculosis cc... ee eeee cease firinding of Metais Silicosis Silicosis Co eec e ee ea ee ee er Sener nan tasecee with tuberculosis .. cece eee devecee SamlhidastSiamlhnidasgting Silicosia ...2..0. Peer mwe serene nc rnee sarees Ste esees Silicosts with tubereulosis cc... peace eect eswcecee Manufacture of scouring powders Siliensis Coc cece eee cece reece ec eee teen cee rer ee Sihrosis with tuberenlosis cc... ee cece ee cece 267 12:20 123 211 15 241 D u MasrellabrouMasrelsabrous Masrellabrous Silicosts Silicosts a Silicosis with baberendishs , ee ee Totai Silicosts coo... : Silicosis with tuberculosis vet 215 } 1.291 Ashestusi Ashestusi Ashestusi Ashestusi Ashestusis Ashestusis ooo. tay st Average Age at Death Yr Duration of Employment o- Longest Yr Shortest Yr Average Yr 61.7 61.7 58.2 62.0 67.0 37.5 62,0 58.0 393 31.0 704 11.2 10.9 10.9 ee | Ad te 61.0 AG09 isa 65.0 117 11 wae era) wat 31.1 1.4 nose rey es Inn 11 2.9 5.0 9.0 5.0 14.0 2.S 1.7 2.3 2.3 2.0 39 0.7 1.5 0.7 ay 90 et 38.4 11 31.7 gu 301.0 la 37.4 es 35.9 1 < 33.0 2s mek ul 11.1 Siete we s, 13.1 ra rary 8.3 oe7.0 21.3 Tt 21.9 ee eee 311 31.2 31.2 eR 14.6 ee 31.4 PEO HORST E SE IAIN Sh R AE TS Oge. Ow On eon + aoe Xs j % 5 JILTH JILTH : im cases of edie gated fully by ories between at death and ek oe - dusty indus- We ew asis the mam A ast sandblasting coer tries with the we Bo tl the shortest eka Another in- alll osis occurred Senet cosis whereas NS -fifths of the age at death pe he cases of as- REO in the silicutic 1 the level of ring powders Et bestosis and Mapes learer and in bestosis cases ae - of the lung iy* Raye ray at (~ ne ~ -1953 Nea uployment 7, Te last Average a " Xr YG Whee sO 34.4 o 31.7 nate ot : 39.0 ANON : 37.1 es So ot 35.0 ~ 33.0 cy ? 13.4 " 33.1 , 7.0 21.3 21.5 Aaa 31.2 16.6 ( the ( the an DUST DISEASES IN GREAT BRITAIN appearances of asbestosis are undergoing some change in that nodular as opposed to ground shadows are beginning to ap- pear He thinks it probable that this is because of the lessened exposure to dust over a longer period owing to the rigorous application of exhaust ventilation to the dusty processes and the use of personal protective devices Cases ui asbestosis however are now appearing in workers who do asbestos lagging of pipes and boilers In this process particularly if asbestos is being sprayed it is difficult to apply adequate protective measures more especially because the workers are usually peripatetic PRESENT POSITION How many cases of pneumoconiosis silicosis asbestosis coal miners pneumoconiosis In all industries there were 8789 deaths from occupational fibrosis of the lung in the year period and it will he seen that the total yearly figures are going up Over the same period there were 6907 deaths from nonoccupational fibrosis of the lungs About two- thirds of the total number of deaths in the occupational group occurred in coal miners who form the largest group about 700.000 exposed to dust inhalation The figures rose steeply from 232 in 1940 to 937 in 1951 in 1952 the figure dropped slightly to 912 It may well be that part of the increase is due to more accurate diagnosis or at least to greater interest in the pneumoconiosis probleur among coal miners In Figure 2 is shown a comparison based on the crude figures of Table 3 between the coal miners and factory TABLE Deaths from All Types of Pneumoconiosis in England and Wales 1940-1951 Industry Potteries co.cc. fete Sandstone _....., ee eee teat teee eer eee core Grinding of metuis etc Refractories ces Leap ceee cates cuceresssens MerilaneouS oo... cece cece ee ccc ccenvccusereccsee minine uther mining Asbestos Lo. cece cee ee eee cee pene eetaeeneeee Cotton hyssinosis cee c ee ceeesueaeeee 1940 1941 53 21992948536 100 21992948536 +1 26 12 7 HIN 5 : 64 59970748722 59970748722 : 59970748722 Total cece cc ec cece rene sceeecessereeunee Nonoccupational .. 00... reece c eee sence eee sess 650 461 1942 21992948536 21992948536 20 7 7 230 59970748722 59970748722 59 7074872 431 1943 21992948536 21992948536 21 7 5 276 59970748722 59 7074872 597074872 ds 1944 1915 21992948536 21992948536 21 6 13 311 59970748722 21992948536 219 2948536 at , 19 357 = 59970748722 1 * 1916 21992948536 21992948536 32 8 14 421 59970748722 59970748722 3 493 655 1947 21992948536 21992948536 27 10 ot 377 59970748722 59970748722 597074872 MIM 1948 21992948536 21992948536 26 13 27 59970748722 59970748722 59 7074872 1949 21992948536 21992948536 37 13 25 Ti 59970748722 59970748722 59704872 1950 1951 219 2948536 21992948536 21992948536 21992948536 9- 21 8 & 70 129129 816 1437 59970748722 59970748722 59970748722 59970748722 59970748722 a 893 1,033 1,113 1,305 +43 en 731731 TS 610 554 679 Total 68 770 327 117 313717 5,506 579 163 te 8,789 6,967 etc. occur in Great Britain It should be mentioned that at the present time it is im- possible to give accurate figures of the popu- lations at risk in the various trades and proc- esses Both the Registrar and the Ministry of Labour classify occupations in groups too broad to give specific figures of the populations in the dusty industries and those in the possession of employers associations and trades unions are not complete It may be possible in several years time to give more accurate information All that can be done now is to state the numbers of deaths reported to the Registrar and to give the figures for one year of the new cases dingnused by the Puemoconiosis Panels The deaths from all forms of pneumoconi- osis between 1940 and 1951 inclusive in England and Wales are given in Table 3 workers In the factory processes the yearly number of deaths was going down until 1943 but there has been a slight rise in the later years In both groups it should be emphasized that the deaths in each year are related to conditions which obtained in mines and fac- tories some years previously possibly 10 to 20 years or even longer New Cases in Factory Occupations The following Table 4 gives the numbers of new cases of pneumoconiosis diagnosed by the Pneumoconiosis Panels in 1953. These tig- ures have been kindly supplied by the Ministry l'ensions and National Insurance but it should be noted that they differ slightly as regards the numbers in each occupation occupation from the figures originally supplied The Ministry Ministry usually classifies the cases as falling into the SO ee VSee s , an aM aS ated AROS ge eat ce i ese weds bth AE ae A. ARCHIVES OF INDUSTRIAL HEALTH DEATHS FROM ALL TYPES OF PRELIMOCONIOSIS ENGL ANDAWN ALEDS 1940-1951 remainder there was exposure for varying periods to other dusts mainly coal dust Addi- MINING NEW an ni aw ae wae 2 1040 IM JAMI 1445 1942 > fl1060 fl 1049 1440 1910 Just tional exposure to coal dust occurred mainly in those industries situated in mining areas such as refractories stone sandstone and granite pottery slate and foundry industries The pottery industry contributed nn et the greatest number of cases 353 mainly silicosis and the foundry industry came next et with 190 cases There are roughly 25,000 pot- a tery and about 220.000 foundry workers FACTORY PROCESIES PROCESIES iron steel and nonferrous ; so it is probable that the pottery industry has a higher pneu- moconiosis risk than foundries Such general i statements are not of much value because the risk varies from process to process within the 1040 1961 1942 1M3 1444 Hey sete Heer 1068 ime 1970 1411 same industry The substitution of ground Fig Chart showing trends of deaths from fibrosis of the lungs among coal miners and factory workers during the period 1940-1951 inclusive category of the last jobs done by the workers Aint by calcined alumina has reduced the silicosis risk among placers of biscuit ware in potteries whereas the ettlingof steel castings is still a dangerous job whereas Dr. G. O. Williams of the Factory Department has reclassified some of the cases Neto Cases in Mining Table 5 gives the ee a numbers of new cases of pneumoconiosis oc- Tt the basis of all occupations done by each curring in all mining operations in 1953 <3 worker in order to determine the most likely These figures show clearly the tremendous A cause of the pneumoconiosis problem which faces the mining industry VOIR There were 896 cases of pneumoconiosis diagnosed and this figure includes 54 cases of There is no space to give in detail the varying Oe degrees of severity of pneumoconiosis found EN byssinosis The cases with an uncomplicated in the 4048 cases but the figures are given A occupational history numbered 665 and in the in the Digest of Pneumoconiosis Statistics kA Table Nere Cases of Pneumoconiosis Np al Factory Occupations ann Other Dust No Other Exposure Exposure Dust rr Industry Exposure t'oal ee Other Total 1 Refractories co.cc. ee ccc Seeee cess oe saeee wee 15 2 Stone workers sunistone granulei n> 10 10 pia 03 e 31 Pottery wo ee . e Oo eee eeees se eee cer 254 US eeves 13 353 splitting 1 Shiite workers Ligiarrying and oe 609 30 es 101 . 3 Foundries occ eecceeseseteecceescuees 130 27 ; 1x 6 Metal grinding other than foundries 7 . ,. 7 7 Sundbdusting ......0.0, a j Cc 4 ... 4 Shot blasting 9 2 : 9 10 ED Furnace dismantling etc. Boiler sraliog . eee . e i i i cy i i 2 . 3 3 s 12 Asbestos oo cec eeee eae EB Abrasive soup powdPTA o 11 - 3 ; > oe : . 14 .. 15 16 17 18 i an t 1 Mee 11 a { Jo ns . J i 20 .. : 21 s Total eee ce neces fl wy ai pt 90 es eee AE ne ST ys 3 = . w 90 the 90 the 3 4 ate +e STbeeds faa fo... Tare x. a Fees. A ae vas cea & bak tide 9 ok TG tare Pe! a aod gs Mo terrae sees + DUST DISEASES IN GREAT BRITAIN BRITAIN ng pe2 hust Addi- ! TABLE - Neto Cases of Pucmocnios Pucumoconiosis 1953 Mining tite miners in which group the lesion was red mainly ; 4 mining . = sandstone # tam, minaeoy soundry in- contributed mainly sili- ee Industry c'ases 41 mining .. 1,019 3 Barites mining Nev, , 3 49 Other clay mining taing cee 143 6 Hematite minunk found to be siderosilicosis often accompanied by tuberculosis Craw's later work 1947 in eliminating tuberculosis from the hematite mines and in improved dust control methods is of major importance Other occupations and dusts which have 4 ( Tunneling .. came next 25.000 pot- TRE I workers or 47 Tunneling BU nesses 3 Total been studied include those of boiler scalers graphite workers grain dockers and workers exposed to beryllium and its oxides to the A is probable gher pneu- esi pe ich general Decause the within the of ground AR ced the sili AEN it ware in te minine Su cases tust Fourteen in chert oil shule or stratified ironstone fire clay miners were also exposed to coul for 1953 issued by the Ministry of Fuel and Power 1954 It can be said however that more than 50 of the cases had had only slight disability and only about % were totally disabled dust of leather mixed with other dusts and to bagasse Attention has also been given to exposures to the dusts of aluminum man- ganese and vanadium and to asthma occur- ring in workers exposed to the double salts dusts of platinum and also to various wood such as western red cedar Pathology great deal of work has been el castings el 5 gives the oniosis oc- RNA The number of cases in hematite done on the pathology gross histological mining is and diminishing but the small numbers found in experimental of coal miners lungs by tunneling are usually instances of rapid and Gough Harding King Heppleston Wright Cloyne Nagelschmidt and others severe silicosis might + CRA 107 107 Dus (~ btn ustry DUSTS OTHER THAN SILICA AND COAL ASBESTOS however state some conclusions about thologythology thology which which which Harding Harding anGdloywnieth colleague S. Koodhouse ( I with our have pa- late late late ar- he varying eoenr osis found ' given about are given i dust diseases Statistics About the middle 1930's the Factory Deartment began to turn its attention to other Justs Middleton in his 1936 review referred to dusts such as tripoli sillimanite kiesel- rived at after studying the lungs of workers in many diverse industries Until the 10 years ago the pathology of was by the class- pclaatsiseisncitallihcoatdic nohdauvlee FdiomginnaotdeudlIantion betehne Katal dustIt high + : ml ; workermade ji guhr tale china clay and fullers earth In ical 3 the same . the same year Doig and McLaughlin pub- way before a diagnosis could be ; lished a paper on the ray appearances of to the lungs of electric welders From this ray or the : has arisen snowstorm effect Classical sili- a world study of the inert cosis usually occurs after the has exposed and radiopaque dusts and notable American to containing a free * contributors have been Sander Enzer Pen- of silica proportion is becoming increasingly dergrass Vorwald and Hamlin Perhaps the : clear free opinion that even small propor- sis which of fibtrhoe- " been most interesting outcome of this study has the alteration of the approach to the : interpretation of ray films of the chest tions of free silica in dust can cause a is composed nodules not of classical type Fig The arrangement 21 \ fibers and rstaedlilaalte 3 ' appbmlliiaexcdked Harding 4 dust fibrosis <4 o- : because the ray features of siderosis bari- the is linear of and the outline i tosis and stannosis in the absence of occu- of the whole nodule is It looks like pational histories and clinical examinations a star Gloyne and I have can be mistaken for fibrotic changes in the the term mixed dust pneumoconiosis : lungs In fact an alarming ray picture is or to this often found in worker who has little or no nodule It has been found in foundry workers especially in i disability The study of siderosis was helped cleaners of iron castings in 4 y the excellent work of Stewart and Faulds to the dust of persons exposed exposed 1934 and later Craw graphite containing about 100 1937 on the hema- free silica and in huiler sealers who are ex- . XN : 91 z z i ; : ? i 3 5 a z a ieee tf re ch * . | .- | ie 5 q | ort os a ; 4 | i uf : ee a i= i es & ; ; ie ( *. s tes 3 : ' Ke % 4 . . 4 3 ; (3 ? a re i a - t 3 . oH ji 3 ee seit , = | 4 St - 3 cet B : | * EPPA p tar het LS f By Trrees dyin ety , Fig 3. ^ 24 M. A. ARCHIVES OF INDUSTRIAL HEALTH ' DUS 9 tore F. arp Ss : ; ; Maris: ple SeIe NRE Classical silicotic mixed dust pneumoconiosis nodule Indeed there are also nodules which show a transi- tion stage between the mixed dust nodule and the classical one Fig 5 It should be mentioned that the ray appearances of the lungs of a worker with mixed dust pneumoconiosis differ little if at all from those of one with silicosis and the disease is just as disabling and as fatal Boiler Scalers Pneumoconiosis ence of pulmonary diseases in ships boiler scalers illustrates well the etiology of mixed dust pneumoconiosis These These men are exposed to mixed dust which varies according to . diec [ exa i the ; nod ? the * reti + car fibr Wet * Up 011 7 431 sili a ' als hematoxylin also according to the source of the water used #0 sui posed to mixed dust with a low proportion of SiO The coal nodule of coal miners pneumoconiosis has much the same appearance as our mixed dust pneumoconiosis undule Coal contains varying proportions of free silica In any case the common de- nominator in those cases and occupations in which this type of nodule is found appears to be the presence of a small proportion of free silica in the dust Where there is a high proportion as stated above the classical silicotic nodule is found But in the same case there may be both the classical nodule and the may Fig Mixed dust pneumoconiosis nodule from a steel fettler's lung hematoxylin and eosin ^ 24 , ia shu Pe pr cat in & th in & a11 3 1 es en % ( Hi a la mixed ; Fig Transition nodule from mixed dust pneu 2. ti 5 ti moconiosis nodule to silicotic nodule in an iron dresser's lung hematoxylin and eosin ^ 24 z P d in them It contains carbonates silicates Z 1 iron and carbon There is usually under % fi of free silica but there is often a high pro 11 portion of iron and its oxides Flue dust : j contains more iron than does the scale on the a c water tubes sometimes as much as 48 In the first case of boiler scalers pneumo- \ | j coniosis the worker had been scaling boilers 5, for over 40 years Harding Tod and 1 Mclaughlin 1944 In 1938 an ray film i of his chest showed nodulation in the upper and outer lung fields and the lower zones reticulation cor micronodulation At that time we made a tentative diagnosis of sili- cosis in the upper zones with siderosis in the + lower zones Seven years later the patient ta Is a 10 me DUST DISEASES IN GREAT BRITAIN died of cancer of the lung and histological . able to study the histological appearances of ve si examination of the lungs showed apart from a proved case of talc pneumoconiosis Mc- ittle and the cancer the presence of classical silicotic Laughlin Rogers and Dunham 1949 et De men- nodules in the upper and outer zones and in A man 51 years of age had worked for re he lungs the lower zones where there was ray 37 years in a rubber factory where he ree coniosis reticulation there were mainly deposits of had been exposed to a fairly high concentra- ( etnis ne with tRT, carbon and iron dust in the lungs with no tion of tale dust Moderately advanced pneu- LAL isabling TAR fibrosis In all other parts of the lung there were nodules of mixed dust pneumoconiosis moconiosis of both lungs was found at autopsy in addition to incompetence of the Experi- Experi- ante boiler edie i mixed eine Me xposed EOI rding to ae BRS ers and ter used ee amg ve ee ce he LP Up to the present time we have had autopsies on nine boiler scalers and all showed this type of fibrosis Only one scaler had classical silicotic nodules in addition But five of them also died of cancer of the lung and this may well have been partly caused by carcinogenic substances present in the soot The change from coal to oil as a fuel for ships boilers has brought with it another problem The dust from fired boilers causes symptoms of bronchospasm or asthma in high proportion of cases and it is likely that this is due to the presence of vanadium in the oil sont Williams 1952 has published an interesting series of cases illustrating this point My colleagues and are at present examining with clinical radiographic and environmental details the boiler scalers aortic valve Throughout the lung substance were scattered small gray nodules more numerous in the lower lobes In some areas the nodules had coalesced to form small masses The fibers appeared to be arranged concentrically around small vessels giving the impression of whorling but not like the appearance of silicosis There were in addition many curious or tale bodies resem- bling but easily distinguishable from ashestos bodies Much dust which proved to be tale appeared in the sections and it was thought at the time that the particles were all fibers More recent work on the lung by Nagelschmidt has shown that the bulk of the dust is in the form of plates with only a few fibers At least three other autopsies on cases of fust pneu- haw an 24 iron ow . silicates mier % Nigh pro- lue dust Lent in on the some 300 of them in the port of Southampton where the boilers of ocean going and large passenger liners are cleaned The investigation has not been completed but up to the present we have not found as much lung damage as was shown in a previous inquiry in the port of Hull where the boilers of fishing trawlers are mainly scaled So far we have found three cases of compensable pneumoconiosis among 50 workers and one case of cancer of the lung together with a tale pneumoconiosis all from rubber works) have been made and they show similar features to the first published case Small surveys have been made on workers exposed to tale dust in various industries but larger ones have been planned to take place shortly It is clear that tale dust though fibrogenic is not so active as asbestos in damaging the lungs Leather Dressers Pneumoconiosis operation between the directors of chest clin- 18 of cases with lower degrees of ics the mass radiography units and the proportion Medical Inspectorate of Factories has been Pneumo- pneumoconiosis and disability instrumental in bringing to light hitherto we boilers Tale Pneumoconiosis great deal of od and has been done unsuspected causes of pneumoconiosis Since work on tale pneumoconiosis the mass radiography campaign was begun ray film in the United States and Canada Dreessen in 1948 for the early detection of cases of The upper 1933 Dreessen and Dalla Valle 1935 Smith and Green- pulmonary tuberculosis some 13,000,000 per- . .er zones Riddeil 1940 Siegal sons have undergone examination Many At that barg 1943 etc. Merewether ( 1933-1934 factory populations have been surveyed and of sili- in England studied the ray and clinical is in the features of rubber workers exposed to tale Nageischmidt .; Personal communication to " patient dust But it was not until 1949 that we were the author 93 ee re fs Mee asoe ais ie 2e4 (1 arn ay a ia Fe me ee Ske ak es te Re rome Fee oe et ee nals ee eee d ee yg. ARCHITTES OF INDUSTRIAL HEALTH included among them have been factories where there is a dust risk The workers at one leather factory were examined by Dr. Hugh Ramsay of the Wanstead Mass Radiography Unit He drew our attention to the fact that one department a high proportion of the workers showed abnormal ray changes whereas in other departments where there was no dust no abnormalities were seen In the department with the high proportion of ray abnormalities skins loaded with china clay and calcium carbonate are dressed on rapidly revolving felt wheels covered with a layer of fine Carborundum powder The job is very dusty though it is done under exhaust ventilation The dust is composed of much fine leather dust with smaller proportions of china clay kaolin calcium carbonate and Carborundum It was found that the dust contained about % of free silica The ray films showed all stages of abnormality varying from early reticulation micronodulation through nodulation massive shadows In few cases there was clinical evidence of disability One man with an ray film showing massive shadows had died from asthma and pneumonia a year before the investigation began and there was no autopsy spite of the fact that up to the present time no pathological evidence has been available it is likely that the condition will fall into the group of the mixed dust pneumoconioses The dust of china clay which for years has been thought to be comparatively harmless is becoming more and more suspect Even apart from china clay the presence of a small proportion of free silica is prima facie evidence that the dressing of such skins is a hazardous occupation Beryllium Pneumonitis and Grandomato- .- remarkable that British experience of beryllium pneumonitis and granulomatosis is not as extensive as that in the United States though many workers have been ex- posed to the dust of fluorescent lamp powders containing beryllium oxide and also the dust and fumes from the alloys Only one death has occurred and the Factory Department has collected clinical ray and environ- mental details of five nonfatal cases one of whom is now very ill The other four cases are either recovering or their condition is stationary It also remarkable that five out of six affected workers were chemists en- gaged in the development of the beryllium lamp powders At the factory where the fatal case of beryllium granulomatosis occurred 150 of the other workers were examined clinically and radiographically and no more cases were found though there had been considerable exposure to the dust of the lamp powders in the early days It is undeniable that beryllium oxide is toxic but examination of the histology of the lungs of the one fatal case has led me to hold the unorthodox view that beryllium was not the sole cause of the condition There were two types of le- sion one of a granulomatous type in which there were giant and epithelioid cells and the other in which were many fibrotic nodules indistinguishable from silicosis Under polarized light many doubly refractile particles were seen in the nodules and an eminent crystallographer stated that these were cristobalite one of the most active forms of free silica This is not surprising because one of the ingredients of the lamp powder is silica gel 25 which in the preparation of the powder is heated up to about 1100C The changed methods of preparing the lamp powder have eliminated both the beryllium oxide and the free silica so that the risks both of beryllium granulomatosis and of silicosis have also been eliminated Pneumoconiosis from Vegetable Dusts -Apart from cotton not a great deal of work has been done on the vegetable dusts The illnesses noted among cotton workers include mill fever a transitory illness which affects nearly all new workers in cotton flax and hemp mills and also in malt houses Monday fever tor feeling weavers cough and byssinosis Byssinosis develops after about 20 years as natural progression from Monday fever and final stage has the characteristics of chronic bronchitis and emphysema As Schilling 1954 says though it was de- 04 sci he sci he sci HEALTH { fax: e of cases Condition is mee: that five out ce hemists en- hn wtberyllium oh ere the fatal Oe is occurred " examined EE uki no more SR ad been con- of the lamp undeniable Ra it examina- of the one Re 1 morthodox sule cause of types of le- ee c in which ee lls and the tic nodules A a nder polar- le particies ee an eminent eT eke were cristo- F free ae one of PNA der is silica ation of the ret 300 The te lamp pow- a2 llium oxide isks both of A silicosis have tah EOP table Dusts ae el seat deal of table dusts Ram, ay en workers cathe Hness which BS cotton flax 4 eione alt houses weavers Don 20 years as iday fever aracteristics sema As It was de- DUST DISEASES IN GREAT BRITAIN BRITAIN scribed by Greenhow nearly 100 years ago its etiology is still obscure It presents an odd Lut characteristic history of chest tightness and breathlessness on Mondays which gradually extends to other working days as the disease progresses In its later stages these symptoms are very distressing but usually remain worse on Monday than on any other day It causes no specific ray changes in the lung fields In the main the workers in the cotton card and blowing rooms suffer must from the disease Strippers and grind ers who clean the carding engines are especially affected As mentioned previously workers with byssinosis are compensated under a special scheme Bayassosis one factory in the coun- try handles bagasse for sugar cane without the sugar and lagassosis lagassosis has occurred mainly in those workers who were grinding bagasse in dry state The condition is an acute bronchiolitis with high temperature severe dyspnea and ray picture of the lungs showing generalized miliary shadows Fif- teen cases of this acute disease have come to the notice of the Factory Department some of these have been described by Castleden and Hamilton 1942 Gillison and Taylor 1942 and Hunter and Perry 1946 The last case occurred in 1948 Since we got the firm to grind the bagasse under water there have been no further cases Farmers Farmers or threshers lung was first described by Campbell 1932 and after that Faweitt 1936 and 1938 did a great deal of work on the condition It has features similar to bagassosis but since it occurs mainly among workers who have been handling moldy hay during a wet summer it is regarded as being caused by a fungus Faweitt was firmly of this opinion Single cases of the condition are described from time to time by physicians in the agricultural districts Pneuanoconiosis in Grain Dockers ner Hermon and Bagnall described in 1946 the clinical features and abnormal ray ap- pearances in a group of 55 grain dockers Thirty of these men had pulmonary tubercu- losis but 11 others had ray changes sug- gestive of the presence of pneumoconiosis Fourteen had normal ray films Analysis of the dusts from various grains showed small percentages of free silica oat dust for instance had % No autopsies have been carried out but it seems that a case has been made out for an extended investigation of larger groups of grain dockers Graphite Pneumoconiosis has been found by some observers in England Dunner 1945 1948 and 1949 Gloyne Marshall and Hoyle 1949 and Harding and Oliver 1949 that workers exposed to the dust of natural graphite develop radiographic changes in the lungs and disability The range of ray abnormalities closely resembles that seen in coal miners Pathological and experimental studies Gloyne and others 1949 Harding and Oliver 1949 show that the the condition falls into the group of the mixed mixed dust fibroses the fibrotic nodules having a linear and radial pattern as opposed to the whorled fibrosis of the classical silicotic nodule Natural graphite contains contains smail per- centages of the order of -10 of free silica There is as yet no evidence that pure graphite will produce a similar condition Manganese Pneumonitis few cases of manganese poisoning affecting the nervous system occurred in the middle 1930's in workers grinding manganese dioxide for use in lamp batteries In 1946 Lloyd Davies reported a high incidence of pneumonia in a group of workers exposed to manganese dioxide dust in the manufacture of potassium permanganate Animal experiments by Lloyd Davies and Harding 1949 confirmed that manganese dioxide irritated the lung tissue and caused intense infiltration of the alveolar alveolar walls and alveoli Later granulomatous changes developed in some instances These results are in line with those described by workers in other countries Fanadium Pneumonitis Wyers 1946 recorded his observations on workers exposed to vanadium pentoxide dust and his results as ek 2 MAT. A. M. ARCHIVES OF INDUSTRIAL Health v a. are similar to those described by Sj^berg 1949 in Sweden The effects are a combination of systemic poisoning and irritation of the pulmonary tissue leading in some cases to bronchospasm and pneumonia Doigand Williams 1952 have described the marked bronchospasm occurring which in workers exposed to the soot of oil fuel which is thought to be caused by the high percent age of vanadium in the soot SUMMARY which make a dusty process more dusty and cause a lag in control methods watery 3. Compensation for industrial pulmonary disease began soon after 1918 and gradually most of the processes and industries which damage the lungs are being brought under wo 3 the provisions of the various Acts of Parlia ment The Industrial Injuries Act of 1946 t. v removed the responsibility for compensation from employers and insurance companies to the Government Since then cases taken under Common Law against the employers have increased rapidly The position as regards the dust diseases contained in Great Britain may be summarized as fol- 4. Numerous legal provisions both in Acts of Parliament and in Regula- lows tions have been brought into force Routine 1. During the past 50 years the risk of sili- of factories and cosis in most of the major industries has been inspection by inspectors mines has been instrumental in limiting the firmly established Until the late 1920's free numbers of cases of disability and death silica was the only dust which was thought to damage the lungs Asbestosis caused by brought about by inhalation of the dangerous dusts the dust of a combined silica mineral came about that time In the mid- 5. It is expected that more accurate infor- into prominence dle 1930's attention was given to the effects mation about the incidence of the dust dis- of other dusts on the lungs such as iron and cases will be obtained in the near future of its oxides and radiopaque dusts china when statistical studies of the information sillimanite kieselguhr tale and mixed obtained by the Pneumoconiosis Panels have clay dusts containing free silica been carried out and when the report of the the middle 1930's also the effects Registrar about the occupational During incidence of disease at the time of the 1951 ~ . of coal dusts on the lungs were given increas- attention and extensive surveys were Census becomes available At the present aye information exists about Are ing carried out culminating in the formation of time no reliable eho the Pneumoconiosis Research Unit of the the populations at risk in each industry and Medical Research Council in 1945. The coal miners numerically constitute the greatest problem of dust discase in Great Britain 2. Despite the combined efforts of inspec- tors of factories and mines physicians che process 6. Surveys of the population by mass radi- . ography to detect carly tuberculosis are Ava, lon, bringing to light information about the ei- . fects of dust in some hitherto unsuspected and research workers the sists engineers deaths from pneumoconiosis have continued to rise yearly The reasons for this increase may be found in more accurate diagnosis of occupations 7. Many problems about dusts and the lungs are still unsolved and some would say that we have only just begun to attack the the condition and in the publicity given to occupational diseases of the lungs leading to mention of pneumoconiosis by more frequent on death certificates physicians But a more of likely cause is the urge for increased speed and the introduction of machines production fringes of the problem Nevertheless a great deal has already been accomplished Assistance in compiling the information contained in this paper was rendered by Dr. P. K. Walker and the members of the Pneumoconiosis Panels of the Ministry of Pensions and National Insurance Drs R. A. Merewether A. T. Doig _ _ Doig A.A. T Unpublished data and G. 0. Williams of the Factory Department 96 Pag bee, MAGES ims LS tdi abe Jets it NS,et AT gh + pad Le us P, t pres! Shae oi vl MA icety 6. RE biel : ert I 28 oe Bt ': SneesACTRN e et sA+ytp7 ot ce i a DUST DISEASES IN GGRERATEAT BRITAIN BRITAIN ASE |: : : bes a $a v2 JaJraryy Tily Tilly hihchich 7 ler riiar-iia1046 ation - to kenken vers - ined julautine utine and and the lelaetathh \ Ministry of LabLouar bour and National National ServiSceervice Dr. II II Harding 4 and E. Harding lately Sheffield UniverUsinty iversitUyniversity and Dr. Nagelschmidt Mines G.G. NagelschmidNtagelschmidt of the SSaafeftyety in Mines Rescarch Rescarch LaboratoriLeabsoratories SheffielSdheffield t ; % BIBLIOGRAPHY BIBLIOGRAPHY BIBLIOGRAPHY BIBLIOGRAPHY and Mortality 1892 1892 ; Arlidge of Arlidge } .; HygiHene ygiene , DiseaseDs iseasesand of .; OccupationsOccupations London London PercivalPercival & Co. | i J. M Acute SSymptyomsmptoms Folowing Following Work Work Campbell with Hay Hay BritBrit M. J. 11431143 1932. 3 Castleden { L. L. 1. M. and , Hamilton Hamilton PatersPoanterson J. .; 3 : Brit Bagassosis Bagassosis Bagassosis An Lung Lung Disease . Industrial H : M. J. 478 , 1942 1942 A $ Collis E. .; :f .; Industrial Pneumonoconiosis Special Pneumonoconiosis to Pneumonoconiosis Dust PhthisiPshthisis , wiwtithh Pub Pub Reference i Health 28 252 1914-1915 1914-19151914-1915 W. Cooke W. W. .: Pulmonary Asbestosis , BriBtrit M. J. J. j : . ' Fibro- Craw .: Blood Examinations Examinations Examinations in Pulmonary Pulmonary Fibro- Haematite 3 ; sis of Haematite Iron Iron Ore Miners Miners TuberclTuebercle { 19 8 1937 Gloyne GloynGeloyne the S. .:.: LesLioenss ions Fiber Workers Tubercle Presence Presence ofof of AAsbesstos bestos the Asbestos Fiber in Tubercle 10 Workers Tubercle Tubercle 404 C -Marshall -Marshall Pneumoconiosis Due 19129929 G. anadnd Hoyle Hoyle, .: Pneumoconiosis Graphite to GraphitGe raphite Dust Dust Thorax 4:31 Pneumoconiosis 1949 of GreenhowGreenhow E. the Local H.: Report Report GovernmGent overnmenGotvernment Officer of MMeedidcialcal Officer Board AppenAdicpespendicesApendices of IV and VI 1860-1861 . Haldane Haldane , J. J. S .; MarinMtarint J. S. aand nd Thomas R. .: J. the Report to Secretary Secretary of State for the Home Department Cornish Department on the Health of Miners Report Cornish Command 2091 H. M. M. Stationery Stationery CommandLondon , 1904. Harding Office Harding H. E TodTod D. L. McLaughlin , Disease A. .: of Lungs in in Boiler ScalSerscalers With a CaseCase Report anandd Review of LiteraturLe iterature , 1944 Brit J. Indust Med. . J. in Pneumoconiosis Pneumoconiosis in a 247 Boiler 1944 Scaler Scaler BritBrit J. Indust Med 100 1947 . Med -and OliverOliver G. .: Changes Changes in in Lungs Produced Changes Produced by Natural Natural by Graphite Graphite Graphite . J. Indust Med . 3 91 Natural Chronic ek > t ; ao |: . 4 ;Po A rey ; ae ; ' . . ue Be, bt 4 hy 33 ye : har CR Pe: TEES ot 7 A sae aR SS ces pt 4 ( : yes : bes af f ; D'A Pul- rous : Med 4:30 Industry J. Special Disease243 Medical CoalminCerosuncil { Control Control and EliEmilnaitimonination ofof SSiilliciocsoissis SilSiliicocsios sisin the West Coast HaemaHtaietematite Haematite Iron Ore Industry Brit . J. Indust 4:30 1947 Hart P. P. DD'A'A Aslett E.. A :Chronic in South Disease Disease monary WalesWales Coalminers Special Report 243 MedicMaledical Research Council , : L Special mior-mior- Davies T. A. .; Manganese Brit PucumoniPtuciumsonitiPucsumonitis Brit J. London 1942 T. A. clise Manganese D. Bronchiolitis clise Med 1946 1946 , Hunter ,and Perry KK.. M..; Bronchiolitis , > Indust 1946 7 3. Harding H. Manganese Pneumonitis : Resulting from from the HanHdalnidnlging of Bagse Bagasse BritBrit Resulting , f fo -and .: Harding Experimental . Further Clinical and Experimental Experimental Observa- J.J. IndIusntdust Med . 3:36:464 1946 Asbestosis Clinical Experimental : Further 1946 Whave Whave ! tions Brit J. Indust Med 6:82 1949 McMDonald cDonald , . S ; Histology Histology of PulmonarPulymonary AsAbesstboseisstosis 1025 of the Electric 1927 ational ational McLaughlin Grout 1 1951 Clearing Lungs present a about about C Effects Brit Dunham Tale ry Lungs ry and Dust GeorgiaGeo.rg;ia ExposuEre xposure --GCCohehoeedseeamslaelnman L HardinIgndust M.Gloyne .; is radriadi is and Woods is are Danner .; Workers 18:33 II the ef Workers Expected ^' 5 ; ; | &. nt 5 . 4 f P 3 : tr Expected i 1945 E. 1950 1 a Grinding of and and Cleaning Castings and the 182Pneumo- and 3 Dealing J. Home uld s saayy i: T. DoDioig g A. T. and and McLaughlMincLaughlin A. .: X Ray Ap- of pearances pearances of the Lumes Lumes of Electric Are WeWl-el- ders Lancet 777171 1936 . in Clearing ofof X Ray SShh adaowdsowsin osis Lancet Lancet osis 778 899 1948 , Welders Welders Sider- Sider- Sider- Dreessen , W. W. .: Effects Silicate Dusts of CertaiCenrtain Silicate Dusts Dusts on the J. Indust Hyg HyHgyg 15:66 1933 1933 Lungs -anil Dalla Dalla Valle Valle J. M Effects of to Dust in in Two Pub Health Rep . Tale Mills 1935 131131 1935 and MiMin nes es DannerDanner Observations Graphite Workers Workers Workers on Pulmonary Pulmonary DiseaDsiesease Brit Radiol BriBt rit j Radiol 18:33 1945 . Observations at at the DevelopDmeentvelopment PneumocoPneiuomsoicsoniosis Brit Brit J. J. RRaaddiiololRadiol -Hermon -Hermon -Hermon R.and Bagnall D. of of GraphGriatpehite 1948 .; Grain Pneumo- and BrBirtit M. J. J. 2: 1025 MMcLacugMcLhLaughllinian ughlin A. I. .; , and and the the Harding H. Silver of SilveSrilver L. .: Iron A BaBrarrireie Oxide Oxide OxidOxeide Dust Dust Finishers FinisheFrisnishers Lancet : 337 337 , 1945 1945 -Rogers -Rogers E. and J. K C . Tale Pneumo- Med 184 1949 -Cheeseman -Cheeseman E. K. K. .; Garrad , .;.; GloyGlnoeyne S. HardingHarding H. .; Jupe M. .; .; LawrieLawrie C. L. cases of of W. Perry K. M. .: Woods H IndustIrndiusatlrial Steel Iron aand nd Steel FFoundory undrFounydry Sutherland Sutherland , LungLung Dis- Dis- , M. StationSetryationery OfOfifcfe ice London Stationery Macklin E. L MiddletonE. Metals of Home Office H. M. M. StationeryStationery .: Report on of Castings , OffiOcfefice London London 1923 4 comiusis in with Dise 4 tuck the + greagtreat Dockers Seeds Brit Radiol 19 1946 in Pneumoconiosis GrapBahgintalel 506 and J. .: Brit Workers , Brit Pneumoconiosis Pneumoconiosis in J. RRaaddiiololRadiol 25273 J. 1949 1949 Council MMeedidcailcal Research Research Council Research eases in South Wales Chronic Pulmonary Pulmonary Pulmonary Coal Miners Parts 1-11 SpecialSpecial Report Special 243 1942 Special Special RRepeoprot rt 1943 and SSpecialpecial Report Report 250 250 19415945 1-111 224 444 -- --- 14T1 -- --- : Pr . P. : National coninsis : Le National Doig ; ; in of Fingrid Fracite Fracite R. R. Fingrid CoCnondditiiotnsions Conditions Langs Brit MeiklejaliMneiklejalin .: SilicSosiislicosis Observations in the 750 PotteriPoettseries Some Some Fracite Radioj Radioj and 354 19319636 in ObservationsObservations Hased on NecropsieNsecropsies Brit J. J. Ocupational DiseasesDiseases ot f he Lamesin Agri- Workers culturaculltural Workers Brit Brit J. Radiol11 378 19381938 Bagas osis lllislonison J. and Notes A. A. of FouFrour Taylor Bagsosi FurtheFr urther Taylor .:.: BagassoBsias gassosis Cases Br Bri itt M. J. 5757 77 1942 Indust MedMed 230 , 1949 Indust History of Eunur Diseases Diseases of Coal Coal MinMeirnesrs Grea of BriBtarinitain 180180-1875 0-11887005-1875 , BrBirtit 1. Indust . Med 127 1951 1951 ( 97 ws ee ee BIN Kadi eetearf t 6, Sig.5 Ete 55 de sp > rt A Ras ASAA Pi H : > A. M. A. ARCHIVES OF INDUSTRIAL HEALTH 4 _ Development of Compensation for Occupational Diseases of the Lungs in Great Britain Brit J. Indust Med 198 1954 Merewether E. B. .: Annual Report Chief Inspector of Factories London p 63 1933 and p 37 1934 Risk of Silicosis in Sandblasters Tubercle 17 385 1936 -and Price C. W Report on Effects of Asbestos Dust on the Lungs and Dust Suppression in the Ashestos Industry H. M. Stationery Office London 1930 Middleton E. .: Industrial Pulmonary Disease Due to the Inhalation of Dust with Special Reference to Silicosis Lancet 2 and 59 1936 Peacock T. .: Diseases of the Organs of Respiration Tr Path Soc London 12:36 1861 Pearson .; Philos Tr London 103 1813 Pneumoconiosis Statistics for 1953 Digest of Ministry of Fuel and Power H. M. Stationery Ofice London 1954 Riddell A. .: Silicosis Studies and Reports of I. L. O. Series F 17 Geneva p 39 1940 Schilling R. S. .: Byssinosis in the Lancashire Cotton Endustry Tr A Indust M. Off 4:61 1954 Siegal .; Smith R. and Greenburg .: Dust Hazard in Tremolite Tale Mining Including Roentgenological Findings in Talc Workers > : Am J. Roentgenol 49:11 1943 5 Sj^berg S. .: Vanadium Pentoxide V OIsn- ys toxication Nord med 500 1949 - Stewart M. J. and Haddow A. .: J. Path & a, Bact 172 1929 -and Faulds J. .: Pulmonary Fibrosis of ee Haematite Miners J. Path & Bact 233 CE 1934 Sutherland C. L. and Bryson .: Report on ~ Occurrence of Silicosis Among Sandstone Workers Mines Department H. M. Stationery Office London 1929 ei ne Repurt on the Occurrence of Silicosis Among ed Granite Workers H. M. Stationery Office London 1930 Thackrah C. .: Effects of Arts Trades and Pro- bem: fessions and of Civic States and Habits of Living on Health and Longevity Ed 2 Lon- don Longman 1832 opam Williams .: Vanadium Poisoning from Cleaning Fired Boilers Brit J. Indust Med 9:50 ml 1952 cn Wood W. and Gloyne S. .: Pulmonary As- ars bestosis A Review of One Hundred Cases Lancet 1383 1934 ar Wyers .: Some Toxic Effects of Vanadium oe . Pentoxide Brit J. Indust Med 177 1946 Asbestosis Postgrad M. J. 631 1949 in at, tte Beet coe NTE ee.