Document zdZ9VZXQjVRGbXQZeNpqnade6

i t the MEDICAL JOURNAL Or /\uon\^LlA Vou n.--87th Year. SYDNEY, SATURDAY, JULY 29, 1950. No. 5. CONGRESS NUMBER Australasian Medical Congress (British Medical Association) BRISBANE, MAY-JUNE, 1950 {Continued) Table of Contents. [Tfae Whole of <h Literary Matter In THE: MEDICAL JOIKNAL OF AUSTRALIA I* Copyright.) Page. SECTION OF PUBLIC HEALTH. TUBERCULOSIS, TROPICAL MEDlCl.VE AMD INDUSTRIAL MEDI CINE ................................................................. .. - 165 SECTION OF PATHOLOCY. BACTERIOLOGY AND BIOCHEMISTRY ............................................................................... 175 SECTION OF NAVAL. MILITARY AND AIR FORCE MEDICINE AND SURGERY..........................................................18< SECTION OF SURGERY..........................................................................-IS? SECTION OF ORTHOPEDICS AND PHYSICAL MEDICINE ...................................................................................................19* SECTION OF MEDICAL LITERATURE AND HISTORY 194 SECTION OF RADIOLOGY AND RADIOTHERAPY' .. 191 THE TRADE EXHIBITION .....................................................................199 CORRESPONDENCE-- Australasian Medical Congress (British Medical Association): Seventh Session ......................................202 A More Realistic View of .Tuberculosis...........................202 The Toxicity of "P.A.S."............................................ .. .. 203 Page. DISEASES NOTIFIED IN EACH STATE AND TER RITORY OF AUSTRALIA ..........................................................SOS POST-GRADUATE WORK-- The Post-Graduate Committee in Medicine in University of Sydney ...................... The Australian Post-Graduate Federation Medicine .......................................................................... the 202 in .. SOS NOMINATIONS AND ELECTIONS ................................................204 OBITUARY-- Sydney John Kewing ....................................................................204 Beaumaris William Stevenson ................................................204 NOTICE-- Ophthalmologies! Society of New South Wales .. 204 Lecture by Sir Howard Florey................................................204 An Appeal for Legacy....................................................................204 DIARY FOR THE MONTH....................................................................204 MEDICAL APPOINTMENTS* IMPORTANT NOTICE .. 204 EDITORIAL -NOTICES ..................................................... .. 204 Section of public health, Cubcrculosis, Ccoptcal Q^eBidne anB SnBustrial qpe&icitte.1 President: D. R. W. Cowan, M.B., B.S., F.R.A.C.P., South Australta. Ticc-Presidentt: Professor A.' H. Baldwin. M.B., B.S., F.R.A.C.P., D.P.H., D.T.M. and H., New South Wales; G. Cole. D.S.O., M.B.. B.S., D.P.H., Victoria; C. E. A. Cook. C.B.E.. M.D., Ch.M., D.P.H.. D.T.M. and H.. Western Australia; A. Fryberg, M.B.E.. M.B.. B.S., D.P.H.. D.T.M.. Queensland; C. L. Park. M.D., B.Ch.. D.P.H.. Tasmania. Honorary Secretary: D. Gordon, M.B., B.S.. Queensland. President's Address. Tasmania had so far done nothing. It was for this reason Db. d. R. W. Cowan (Adelaide) took as the subject of his presidential address "The Role of the Voluntary Worker in the Coutrol of Tuberculosis". He referred to the steps taken at the Perth congress to establish an Australian Tuberculosis Association, and he recalled the fact that in speaking to the subject on that occasion he had quoted a statement by William Osier that by "joining actively }q thv work of local and national anti-tuberculosis societies" medical practitioners could help in the most | that Dr. Cowan had chosen his subject. It only required somo ardent soul to give a lead and the rest would follow without much trouble. Perhaps an isolated individual could do little, but joined to others in an association. h might be able to accomplish much. Voluntary association: would not embarrass official efforts; the best results wouh be obtained by a combination of both. All that govern mouts could do was to formulate plans, to provide mone- and facilities, and to give a lead. Without the help of tb medical profession and the people a government could nc important and most hopeful campaign vver undertaken >i the profession. Gratifying progress had been made with make its plans effective. Though governments had don much, they had left much undone; they would go o t`K' Australian Tuberculosis Association; coluntarv assoria- Paving it undone unless urged on by the force of publ ' ...... - ...... ' ' r..i,ov1 ,,f Hr. M. 29, mo. THE MEDICAL JOURNAL OF AUSTRALIA. 173 . the prevention and/or limitation of paralysis, cause disease depended chiefly on its composition and ** '"pe(j to the difficulties associated with a diagnosis nature, its particle size, and the intensity of exposure. "t^noaralytic poliomyelitis". Until it was possible to In addition to dusts containing high percentages of tree with precision which patients actually were suffering silica, others Iron which free silica was absent (asbestos "* poliomyelitis, research would be hampered, and at and certain metals) were capable of producing severe ^rw,eld patients admitted as suffering from "non-paralytic pulmonary damage. In most dusts, asbestos being the Hnrnvelitis" had been found to be suffering from mumps. exception, the harmful particles were those less than about mononucleosis and other conditions. He was S-Om in size. Intensity of exposure, which varied for meed of the danger of moving patients over long different dusts, depended on the atmospheric concentra Stances and urged that If patients had to be moved, tions of dust and on the duration of exposure. Dr. Smith mt should be transported to the nearest base hospital gave a brief account of a case in which silicosis developed nd not to an infectious diseases hospital, perhaps many rapidly. With regard to the main occupations and dusts ides away. provision of an adequate supply of respirators associated with a risk of pneumonokooiosis. Dr. Smith !* important, and, at Fairfield, some two doten which mentioned diseases caused by silica, coal and asbestos, and ti been built during the earlier epidemic had been avail- also the radiographically evident abnormalities of certain ble at the outset of the 1949 epidemic. However, many of basalt workers and biograph operators, and the pulmonary m were child respirators and useless in the recent effects of talc, graphite, cement, zinc, cadmium, beryllium, nidemic. when most respirator patients bad been adult manganese, iroo, aluminium, synthetic abrasives, cotton, ccordingly the policy of his hospital now was to build bagasse and wheat. He also drew attention to the occur aly adult respirators, which could be adapted for use for rence of pulmonary carcinoma in workers exposed to atients of any age. Dr. McLorinan could offer no explana- chromates, arsenic and asbestos. Dr. Smith then set out Ion of the shift of the age group incidence in the Victorian the following nine measures to be applied in the suppres pldemics. Da. C. E. Cook (Sydney) said that Dr. Cole's paper opported his own experience in the Western Australian pidemic in regard to "age shift" and the higher mortality jnong country patients, which he thought had perhaps eeulted from their transport to Perth over long distances, tfany such patients had been sent in ambulances past wse hospitals with respirators and had arrived in Perth norlbund. Dr. Cook asked had there been any investiga sion and control of dust and in the protection of workers: he said that they did not vary with the industry or with the type of dust, (i) The abolition of processes creating harmful dust. If that was not possible, the total enclosure of such processes in mecbaoically ventilated structures, or their segregation from other operations in the factory. Isolation could be applied either geographically or by time--the carrying out of a dusty process w'hen no other workers were in its vicinity, (li) The use of a harmless ' material in place of one that was dangerous, (iii) The tion during the Victorian epidemic of the question of removal of dust at its point of origin by local mechanical mortality among pregnant women, who had contracted poliomyelitis, to which attention had been directed by Snow. In the Western Australian epidemic, of twelve pregnant women who contracted poliomyelitis, six bad exhaust ventilation, (iv) The use of water or other wetting agents to prevent dust from certain processes from becoming air-borne, (v) Electrostatic precipitation, (vi) The provision of adequate general ventilation to dilute turvived and given birth to female Infanta, and six bad contaminated air. (vil) The maintenance of a high stan lied, five of them bearing male infants, the sex of the sixth dard of plant cleanliness and housekeeping. (viii) child not being recorded. Personal respiratory protection of the worker. Respirators Dr. Cole, in reply, said that in Victoria no action had should be worn only when other methods of protection seen taken regarding food supplies, but the Consultative were not practicable, or for jobs of short duration. The> Council on Poliomyelitis had recommended the boiling of should be well-fitting, comfortable and efficient, and should milk, and that recommendation had been interpreted by be kept clean, (ix) Preemployment and periodical medical milk interests as an attack on the industry. It was not examinations, including chest radiography, of workers considered that Ice cream was likely to be a vector, pro exposed to a dust hazard. vided it reached the consumer after pasteurization and packaging in a factory, but ice cream dispensed from metal containers in retail shops could be contaminated. The closure of schools bad always been opposed In Victoria, unless some special reason existed, and, in the 1949 epidemic, the Education Department had been asked to exercise clemency in those cases in which parents had kept their children from school, and not to admit transferred children to schools until those children had resided for not less than two weeks in the new area. The closing of kindergartens did not interfere with education and parents had been advised to keep young children at home. All schools had been urged to abandon, competitive sports on account of the risk of precipitating paralysis in children, who might be in the incubation period of poliomyelitis and la whom exhaustion might have disastrous results. Dr. Cole said that lie had no information regarding polio myelitis in pregnant women. Dk. W. E. Geokce (Sydney) said that in investigating cases of pnouinonokoniosis, it was important to obtain a detailed record of former employment, as there was s tendency for a man changing from an industry with a silica risk to another non-siliceous industry, to suppress information of his earlier occupation. Unless, too. a carefu occupational history was taken, ridiculous errors migfr arise. He quoted the case.in which a radiological repor had been received from a large Sydney hospital of "typica pneumonokoniosia", the patient being a bank manager Speaking of coal miners. Dr. George said that intermit tently they were exposed to a high concentration of silic; dust, particularly when shaft-sinking, roof-brushing o- driving in sandstone, and, as coal raisers, they did no realize the dangers of such dusts. It was at times difficui to estimate the number of years during which a coal mine had been exposed to dust risk, as coal miners worke- intermittently at their occupation. Probably a third o Dr. McLorinan said that in the Victorian epidemic, of 45 women over twenty years of age who had been admitted jo Fairfield with poliomyelitis. 14 were pregnant and three had died, hut no record had been kept of the sex of their children. i 1 the number of years a coal miner said he had worked i: the industry could be deducted before an estimate of th actual years of employment was made. F.xpcricncc ha shown that unless there was fr*-*- silica in the dost inlialcc if was unusual for tul>erculou.s complications to develoj Occupational Factors in Pulmonary Dust O'Seasc. Many of the industrial dusts were not of great important-because only small numbers of employees were at risk at: Du. G. ('. Smith (Sydney) read a paper entitled "(nu-u- in factories the dust problem could be d^-alt with bott< national Factors in Pulmonary Must Disease". M<: staled Ilian in coal mines, hut it was a good working rule dni.niii.,,, ,,( a<loi.t.<j at the .Third roc.-inl all dusts as harmful. At the recent I'm-nmoii ' ........ ' Sv.v:.'v 1 :it y that fr. THE MEDICAL JOURNAL OF AUSTRALIA. Jui,T 29, 1930. o Jut* (saver (Sydney) said that be was been thought that a hazard existed to those handling bricks urge's last statement, and referred to in such circumstances. ice inspector in his late forties with *10 twenty years earlier bad spent five : K&lgooriie. At times it was difficult Mi in some fibrotic cases, and he irded as pure silicosis with *'a snow- In which two years later tubercle d with no demonstrable changes in re. Commenting on the case of the pb operators) quoted by Dr. Smith, : he bad examined them both; one na and was dyspnmic and disabled, brother with equal evidence of 1 no emphysema and was fit to coo* an illustration of the evil effects of iphysema in such cases. The Diagnosis and Control of Smallpox. Da. C. L. Park (Hobart) discussed smallpox. He said that with the advent of aircraft the possibility of the Introduction of smallpox into Australia was increased. As Australia was largely an unvaccinated country, the quick control of such a disease would depend on the isolation of patients at the earliest possible moment and on the prompt taking of precautionary measures. Smallpox remained endemic In certain eastern countries, with seasonal epidemic prevalence in the first quarter of the year. The causal agent was a virus, which was stable, and which retained its viability under unfavourable conditions of temperature. It was spread in two ways, directly frost person to person, and indirectly through fomites. The rox (Melbourne) said that two incubation period until the development of tbe rash was jortance. One was whether a pre- fourteen days; the period was Irregular in modified small, ; necessary before pneumonokoniosis pox. The invasion period was characterized by an abrupt was whether removal from exposure onset of tox*mic symptoms, which subsided on the appear the disease. In bis own experience ance of a focal eruption. The eruption was at first macular; then papular, vesicular and pustular stages followed in regular sequence. The last stage was the sbane) said that at times it was good industrial history and the uld help the clinician considerably drying stage when crusts formed; these left a pitted skis surface when the crust fell off. Buccal lesions appeared early, and the rash preferred the upper halt of the body * were known and foundries had tion to dust risk. There was a in to associate disease with occupar example, that a painter suffered - to the lower half. It was a rash of the face rather than of the arms and legs; of tbe distal ends of the limbs rather than the proximal ends; of the back of the trunk rather than the front; of the extensor surfaces rather - that a sewer digger was exposed than of the flexor surfaces. It shunned the most pro as, is fact, It might be only certain nounced flexures such as the axilla;. The centrifugal i which were dangerous. Again, distribution gave tbe key to the diagnosis, as Ricketts had i In different localities might be shown in 1908. The laboratory diagnosis was made (!) by not in another, as exemplified by the detection of the virus in scrapings from lesions, and structors in Sydney were working (ii) by the detection of variola antigen in vesicle fluid. i Brisbane they worked in a schist The differential diagnosis had to be made from (I) measles p and offered no hazard, in the early stage, (ii) chlckenpox, by the distribution ol of the difficulty sometimes encoun* t was made to trace the past patient. Dr. Gordon referred to a worked in an atmosphere con- the lesions (chlckenpox was a rash of the body, smallpox was a rash of the face), and (Hi) drug rashes. The clinical history and the distribution of the lesions would help. Formerly treatment had been by administration of ; it was at first puzzling as the ity of exposure to silica dust, but that at an earlier period he had 3 in the abrasive soap industry, agassosis occurred in Queensland, i the handling of dry bagasse in 3 the custom in the cane mills to ces, the resultant ash containing exposure of boiler cleaners was -' . and they were not subject to of patient who caused worry was equently a grinder in a factory, imination showed almost massive tubercle bacilli could be detected. .t such a man off work, but there the sulphonamides; these had been superseded by penicillin and streptomycin. With regard to prevention, Dr. Park said that successful vaccination and revsccination would give absolute protection. Administrative control required isolation of patients and vaccination and surveillance of every possible contact Two complications might follow vaccination, post-vaccinal encephalitis and generalised vaccinia. Encephalitis was probably due to the presence of an unknown virus previously introduced into the body, but quiescent until activated by the vaccinia. It affected only a few countries, and tbe safest method of avoiding it was to carry out primary vaccination prior to school age. Generalized vaccinia was rare in adults, and nearly always affected children; it affected only those vaccinated for the first time. y that he might be harbouring Dr. Ctril Cook (Sydney) said that the subject of small llow workers. pox might at any time be of great importance to the :d that the points raised by the the importance of industrial he had said in his paper. Referrks. Dr. Smith said that it was the actual degree of exposure of here was no doubt that at times ninstion of affected coal miners' that they contained less silica ;! cases of silicosis. In answer th said that in many cases of medical profession in Australia. It was important to determine the values attaching to the work of Wilkinson, of Hong Kong, in relation to vaccination. He claimed that it gave protection for two years and then its effects rapidly waned, first in relation to toxaemia, then to the number ol lesions and finally to maturation of lesions. Thus it was possible for a patient with smallpox, vaccinated more than two years previously, to die of toxemia with no rash, or if contracting the disease at a later period, to have f* lesions and yet die of toxamia. sposing infective condition, but In Australia there were now a large number of vac' filial to the development of the i cinatod ox-snrviec personnel and an outbreak of smallT** ace. removal from exposure to . might present many diagnostic difficulties, because ii infec rcss of fibrotic changes. In tion occurred within the first decade after vaccination. tW that recently a brick `dragger" ; number of spots on the body might he of little help in ow, and not entering the kiln, diagnosis. Another question for consideration was thf dvanved fibrotic changes with socall'd "immune read ion". Until i>c<-nt!y i; had um. ami it had not pr.-vimi dv tlfll)<rU'.,,d flint ....................................' | fluent revac f now said t i nod, if o. c had been fr i protected, q { nod others, -take". in i "immune re of raccinatl that protect: the number lesions--it l maturation would be fc < pustule--sea ? revaednatio; } papular reac '*. Da. E. Nc .? "The Patboi so-called Ko< v Jenner had c as an allergic ' pointed out reactions--ba latter tended foreign prote appear tor so Jr\ bacterial alle importance ii to distinguist *.; the true Man 4' simistic rega smallpox bee* with which traffic--at pr week between were all vacc smallpox arr manifest a person could pass the most been vaccinate pox very diffi Instance. Ca the greatest detecting sue! the doctor in by ail practl persons who Speaking size of the about the lin and, as the technically Jtec-Presidcnts M. Macke-- Da Rkoi.v persp remarks hi morbid an; `"mer stone _ lTh* mectl Nbwh.ii,, Ti' >>! i: t.\ ,'J. 1W0. TUB UliDtUAL JUl'U.VAL 01-' AUbTUALU. 173 o'.! .it Ui iireveOuxin aud/or lliultatixju ( i.uiulysi*. cause disease depended chiefly on us composition and ii. ii .,'gu-eu :o Hie duficuliiex associated with a diagnosis . nacuro. us particle lire, end the isteasiiy of exposurs. 1 Ml i.ui'ulvdC (luiluiiiyelKlS Until It -vis ip..sj.1,'iii In In audition to dusts containing high percentages of free < "lid inctuiwii *Mit palluMt* audio))/ *wt >Ullellli I. ... ;.,,n.,myciins. rcseurcll would be r.iiu.iigicU. .in.I it siIks. xuiiera from winch free silica was absent (asbestos end certain metalsi were capable of producing severe r.,i,..iij i.oncnu juuuUcU ai suiTurnig (igin ;wu nuiaiyitc ..............ut> 1 1.4.1 bcgti tauutl to do uttering frxilu mumps. pulmonary damage. In most dusts, asbestos being the exception, (lie harmful parcicfee were those lets than abool ."i. .in- .uwm.nuciuuais ami xiiligr conditions. Kg was C da in >ixe. Intensity of exposure, which varied (or ........ of die Jdiigef at moving jiaiicnu ..vcr lonii - different dusts, depended on the atmospheric concentre, ikijiuvs ana mggii that i( pausult liud to be moved, (tons of dust and on me duration of exposure. Dr. Smith n... \3uiild be ((unspoiled to the nearest liuc i.ospiixl . gave a brief account of a cate In which silicosis developed ml n,,i to an mleclioue diseases Hospital. perhaps many I vapidly. With regard to the aieia oecupecione end dbsu ...... .. ><> provision of an adequate supply o( rgsimatoi* associated with a risk of paeumonokontoeie. Dr. Smith >..> m.|.o<!ani. and. at Katr'iuid. some two Jutai which : incmioned diseases caused by silica, coal and asbestos, and ..i Oxgo limit during me earlier epidemic Had been avail, i also the radiographically evident abnorreeiltlee of certain .1... ui Hie outset ot the KM9 t-|iiduimc. However, many o< I basalt workers and biograpli operators, and Uii pulmonary it.. xx. ig guild restmatots and useless in tin- l otviit - effects of talc, graphite, cement, tine, cadmium, beryllium, .I.I.niK when most reSpirnUir IHHvIttS Hud been adult. luxiiigaueso. iron, aluminium, .synthetic abrasives, cotton, ........ . the policy of nu riosmtal now was cu muId bagasse and wheat. He also drew attention to ilia occur .. .,.|.|II I.xfirataix wiueli g.mlil be aduplrtl i.n ,i>,- (hi- rence uf pulmonary carcinoma in workara exposed to , 1C. III. ( any age !`r Mvl.'-nii.in .oiiJd i-<U-i- > .\|.1m.a x.iiiomatcs. aisetiie and asbestos. Or. Smith then set out ............I Hi. all ill of II.. adv gl-up ......................... t I. tui 1..11 tiie full..wing nine measures to be applied in the tuppree- . ,od. iniea. >Kiii uud lonii'u! ui dust aud In the protection of workers; uu ..aid that they did not vary with (lie industry or with c. i_ U Com. Sydney i 'aid that U. Cole a paper die type of dust. (I) The abolition of processes creating i.imn/lvd his oan x .ipcrigucg ill me Wesluiit Australian harmful dust. If that was not possible, the total encloture ....mix' 111 regard -... dg.; sl-Xt" and (lie lilgllel' miillalltv ..la ....... 11 y ,.t> XV11 lx i, I.g Uiuugl.l lead pci Hups ( sueti processes m mechanically ventilated structures. .>- (hen- segregation from other operations m the factory, r.ixiilxd (ruin llieir tiam.iu.it t.1 1'eitli over .oily, UiXuiuxe Mai.) surd ' patient* had been sent m ambulance* past isolation could be applied either geographically or or time--the carrying out of a dusty process when no other ta.i ii..>|ii(aU Willi lesiilraiois and had arrived in Perth workcre were in its vicinity, ill) Tbe use of a harmless ....Ml,and Dr Cook naked had there been any mvgiuga- . material In place of one that was dangerous. (Ill) Tbe n..ii during the Victorian epidemic of toe question of : removal of dust at Its point of origin by local mechanical iii. .riaiHy among pregosm women. wbo bad contracted 1 exhaust ventilation, (iv) The use of water or other wetting tviimiiyvlitii. to which attention bad been directed by . agents to prevent dust from certain processes from >n... in tue Western Australian epidemic, of twelve becoming sir-borne. (r) Electrostatic precipitation, i vi) tiii*iuiii( winneii ho contracted iiullomyelitls. six had | The provision of adequate general ventilation to dilute turiii.-d a nil fiwti uirtb to female infanta, and six had ) couuimnated air. tvtt) The maintenance of a high stan ji..i u\g of mem bearing male infanta, the sax of the suib I dard of plant cleanliness and housekeeping. iviiii Inixl nut being recorded. Personal respiratory protection of the worker. Reeplrator* it Cole. In reply, said Hut in Victoria no action bad I should be worn only when otaer methods of protection been ukvo retarding food supplies. but the Consultative I wero not practicable, or for lobe of ehort duration. They Cvuiixil on Poliomyelitis had recommended the boding of t sAould be wfij-SttJBg, comfortable and efficient, and should milk, and that recommendation had been Interpreted by i be kept dean, (lx) Preemployment end periodical medical Bilk latvnttt u an attack od the industry. It was not examinations, including chest radiography, of workers roasttiered that Ice cream U likely to be a vector, pro exposed to a dust baaard. dded It reached (be consumer after pasteurisation and i-aikegtng in a factory, but lea craam dispensed from metal loataiaere In retail shops could be contaminated. The tlueare of schools (tad always boon opposed in Victoria, ealvas soiuo ipsclal reason existed, and. in the 190 epidemic, the Education Department had been asked to eierclee clemency in thone coses In which parents bad kept their children from school, and not to admit transferred (biidrea to schools until (boas children had resided for svt less than two weoka la tba new am. The eloatag of kisdergertcoa did act lawrier* with education and parenU bad Wen advised to keep young children at home. All Kheutn bed been urged to nhnado* competitive eporta a acceuai ef tbe rlak e< precipitaUng paralysis In children. be might be it the Incubation parlod of pollorayelltla and ta ufeew exhaaaUod night hard dlaaatroua results. Dr Cete said lhag ha had ad information regarding polio- reiftie la pragaaai worn**. lie itcUriaaa said that la tha Vktorlaa epldemle. of li vwasa over iwcaty year* of age who had beea admitted ta PairfMd with poliomyelitis 14 were pregnant and three had dltd. but no record had been kept of tlic sex of their Da. W. S. CtOKUk (Sydney) Mid that In Investigating cases of pneumonokonlosis. it was important to obtain a detailed record of -former employment, as inert was a tendency (or a man changing from an industry with a silica risk to another oon-tlliceoua Industry, to suppress Information of his earlier occupation. Unless, too. a careful occupational history wan taken, ridtculoua errors mtght arise. He quoted the case in which a radiological report hud beea received from a large Sydney hospital of "typical paeumoaokonlonia", tha patlant being a bank manager! Speaking of coal miners. Dr George said mat intermit tently they were exposed to a high concentration of silica dust, particularly when shaft-slaking, roof-brushing or driving in sandstone, and. as coal raisera. they did not realise tha dangers of such dona. It was at times difficult to estimate the number of years daring which a coal miner had beta expoeed to dust risk, to rant miners worked intermittently at their oeespetion. Probably n third of the number of yearn a coal miner said ha had worked la tbe industry could be deducted before an estimate of tbe actual years of employment waa made. Experience bad shown that unisee there waa tree silica is tba dust inhaled, WUdieS. __ it waa unusual tor tuberculous complications to develop f-^^0*eU4ll*l t lulBig IA Pulmonary Duet Oiseaae. \ ' Many of tha Industrial dusts were not of great Importance, because only small numbers or employees were st risk sad [ Via U C Suuu (Sydney) read n paper entitled "Occu- lu factorial (he dust problem could be dealt with better paitsaai )'s. tore in Pulmoonry Dust Alsesse". He stated I than la coal mines, but it was e good working rule to (to 4lltle ui pucuuionokonloeis adopted at tUe Third | regard all dusts as harmful. At the recent Pneumonolawsaileissi Conference of Experts on pneuiuuuokonioeia I kontoeis Conference la Sydney the poeelblllty cast tree h*U et didney early la 1950. tad outlined its Scope. Dr. i silica might reactivate tubercle SaeJUl of low virulence gAUb titceeoi iho need tor a complete and accurate | bad been mentioned, and it waa suggested that ''8.0.0." ecvepetieasi kUiury In die diagnosis of pulmonary dust f might have its virulence raised It subsequent to Us 4w*eee He said that Hu puientini capacity of a dust to 1 administration tree silica dust was inhaled, 1 l f u ? !f* ' . ............^n,-%K,.r,rt3i9 w-n ; viu\ -- tr "A.-. - - - t I -- ' ' 1,1 l"' ill ill"* at KAIg"Ol "" u -..in- < ,r "v- i ! it > I ..................... "lira mill a- ............. ,-n-ix--. .n -I J< oi-x "H -icrAiili npornt'.r* tnutr'l >.> 1 '.inn r i.\.a UlUt ill* AVI - n-1il[l"(i 'III'III .."I" . >:. i> . i.-aa...........it ruvii "ii[''Vii>i"srombarofitnhret r *i>v.i-.-iIvyo.ni(-Ti-A*i' vi<.(, ii"H!iM'i'i-"; ( a; [i"i i.-At < A "iC 'f .* A-i U'HAf y rrt'AStif.-* A-j-'Miiy ;:i 'AAtefU ^""i" -pidemir pm. m.once in in' 'irnt ........... had no ni;im ."i:.\ .mil .ia in ;> ..m ..... nn 'no wtk an lilostrat > ( i:v- 'tTpria <li'>>>iii[ii]ii'Ot "OiphyeeniA -n vi.-h "As"v i *n A; > m 1*7v i \ n rn \ Mcl h-.-i rno ' < i .! : at - " ".*<linnn *rr* nl iinforiani'c "'rio v*a* M"tltiif a r>re :.i>oam* mfivtion *.\a noroaaara ......... ....mala aijSAi IgefU was A . iru*. Win.H 'tamed its >itulity .mfler >u-fA\'iiiperature :t j npmad m iw/ .-''rson in person, and mdir"iiv tr nruOAtion pormd imtii 1 i" u.-.-nun f-urtf-n d*. tn :'<-riou *as .rregii l'"t VV* m\Auin tinriod w-aa i-inr' -A* ..."-lili-a )i,, '*l h' 4ft AfK i">"ii>iit*d The otnor WAS wii"t1ipr i ......... ft-m a|'nnrc nset "f mzv*llll. mniptni'H will.h | .""."ied pro*7P of the rtlaossp ill ni ..an "ip"f|n"" Mine -f 1 fv-Al .................... i lip r ' bid not. niAi-uiAf. ......... ;>-i |iurvr. f -ltnwi-il In r-auiAr smurii' r Th< l)i(. 1> G"nmia . ilrialmn** An| Unit *i ":iu-* it "AS llitlmll "nrain a xuml indu-iinai ii"*<-"' -vnl tna iijustrlitt * > cii'iiis) - ........ p t:in rlim.-ian "iianloi Ahi> iiruiM* diUUi-mu* inn wn* xi|.<wn an" ` in.irn>a <tArt Irvinie CKgi- wn--n "u*tA forinrd ti -hirfArt* iifll 111" iriiAt ft-U "il ft. 'nriy. And me rnsn pri.f'rr"t lh" n; i'i in" l.iwnr iiiuf li wa* A rtsii nf f; A ;'U>-'U krn -iooa *'1 Ilf -f v.e *.. -Aipv. ---An 'II .lamll--1 in r.-'AUon l" iti> * a* a ( h rills mrt * -if 'h" -tlsIAl "*i i s -f .......... 'ndt-no f-*r . .inu'inn to mm air -H-- ..................--i-A All.-- -AAt. Ill' r i nn A i -"-Is ,.l -I.........< ..f 1*1" ' on And U. i<iuni" tor i,vni'ii' 11 At A . ai'it* - I'far-il V... i iAli III" front "C Ho* "kt.-iist" irrA.-" 'Alri'r 'in h-ad p-iv.......nit. nr rnat a .-"r iIik-;-" . M.oai'd i-1a11 -f lb.- il--iir siirfarr* " sn-inii"ii in.- ni-*i :>r-. a dust Hazard wh-*fA. in fart u "iieni ,, > ri.Ain *| < ion* "f an inrliiatry a i.n'li won- rtAm:>-: Again. an Intlnalfv .arm'd on m iliIT-r nt I"' i,i(i" n--rn'-'d ft'-Min-A urn a* l"" Atnlip T`i "ntriluxai diAtrilmtion Ae Uic Key to lli" -iiagnosiA ,\s itirkults nati nnwn in I'll*" TIi" lAhorAtory oiatnnsu ,vas m.ide .lit.. tiinaerons .n mir And not m n.>itu-r an -v.i uli.il tiy Hi" -ic-tcrtH'ii -if the viruA in ArrAi'iiiXA (mm lesions, and ini- fill'! tljal ai'wnf cixiatfuctiira in Sviinrv war w'rKUtg mi iiy the r|"tectlon of variola unticm m vesiel* rtuld III AAlidAlon*. wlier"ft in HrlAhnni* 111 -v k ^il in irlunt Vh" OilT"r"iitiAl iIiaehoaia lind to 0" tuAde fmm i > measle* which wm iimmlly damp and "IT"r"rt no n.ir.arrt hi me early stage, -iii "hicxeMpox. by ti<" oiAtnbution n( in further lilustritlou of th dimi-ullv siuurmiu** nroun- me leAioue irhickenpnx *m a rash of me body. Amailpox torrd when an attempt >a> matte to tram me paat i waa a rash Of the facet, and Mil) drug rasne* The Industrial history of * portent. Go I'uftlon referred to a man with (lllroel* wlio worked in nn atmoaiiliera 'on 'ilnirAl luAtorv and the distnhution nt u - i-xi'ini w-mid Hnin Formerly treatment bad been by Auniinmranon of tnnilnated with chlorine; It was at ilret puzzling aa the . the RiilplKinnmides: these had been uper.a-<l u> penicmio man denied any possibility of exposure u> llira dust, but : And streptomycin. With regard to prev.-ntion. L>r i'xrK 'ventuallr X was found that at an earlier period he had ; ald that aucreaaful vacelaetlon end revaccmauon would worked for thirteen year* In Ifie ahraalre *..p >ndutrv . give absolute protection. Administrative "nntroi required : leolation of patients end vaceinatloo and turveiHanc* "f Dr Gordon said that begSMoel* occurred in Queensland, i 'very possible contact. Two complications might follow hut the main risk lajr lo the handling of dry haeasse in { vaccination, post-vaccinal encephalitis and generalised lofts and. although it was the custom in the rane mins to i vaccinia. Encephalitis wm probably due to the presence burn waste in the furnace*, the resultant ash rnntainlog I of an unknown virue previously Introduced Into the body. about 2Srtr of silica, the expoeure of holier cleaners was 1 but quiescent until activated by the vaccinia. It affected limited and intermittent, and they were not jnbltei to I only a few countrlea, and the safest method of avoiding any great risk. One type of patient who mused worry was It wm to carry out primary vaccination prior to acbool the elderly man. not Infrequently a grinder In a factory, age. Generalised vaccinia was rare in adults, and oetrly who on hit first X-ray examination showed almost massive always affected children: it affected only those vaccinated fibrosis, but In whom no tubercle bacilli could be detected. for the first time It wea not desirable to put such a man off work, but there was always the possibility that he might be harbouring Da. Ctui. Cook (Sydney) said that the subject of smell- ibacilli and be a risk to fellow workers. Dr. Smith. In reply, said that the poiote raised by the speaker* In reference to the Importance of industrial histories emphasised what he had said In hit paper. Refer ring to Dr. George's remarks. Dr. Smith aald that It was very difficult to ascertain the aetual degree of expoeure of coal miners to silica, and there wm do doubt that at times they were at risk, but examination of affected coal miners' lungs pe*< mortem mowed that they contained lees silica than was found In classical caste of llfcoote. in anewor to Dr. PeaiagtM. Dr. Smith said that in many cases of pox might at any time be of great linportanca to the medical profession In Australia. It wm Important to determine the values attaching to the work of Wilkinson, of Hoog Kong. In relation to vaccination. He claimed that it gave protection for two years and then its effects rapidly waned, first In relation to toxamla. then to the number of lesions and finally to maturation of lealos*. Thus it wm posathfa tor a patient with smallpox, vaccinated more (hen two years previously, to die of toxwmia with as rash, or if contracting (ha disease at a later period, to have tew lesion* end yet dls of toxamia. silicosis thsrt was s predisposing infectlv* condition, but In Australia there were now a large number of vac that wm not a factor essential to tha development of the cinated ex-service personnel and aa outbreak of smallpox disease and. la hie experience, removal from exposuro to might present many diagnostic difficulties, because It Infec dust did not arrest progress of flbrotic chaogta. In tion occurred within eh* first decade after vacclnetion. the conclusion. Dr. Smith aald that recently a brick "dragger" number of spots on the body might be of little help In loading bricks from a barrow, and not entering the kiln, dlegnosla. Another question for consideration wm the had been found to have advanced flbrotic changes with so-called "Immune reaction". Until recently it had been tubercle bacilli In bit sputum. And it had not .previously understood that an early papular reaction following (re- C 1677 .V'vivfewfi'1**