A Roentgenologic Study Of The Effects Of Dust Inhalation Upon The Lungs

Our plain-English summary of A Roentgenologic Study Of The Effects Of Dust Inhalation Upon The Lungs, by H.K. Pancoast, T.G. Miller, H.R.M. Landis (1917).

The study

• Authors: H.K. Pancoast, T.G. Miller, H.R.M. Landis
• Published: Transactions Of The Association Of American Physicians 32:97-108, May 2-3 (1917)
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library, J-M no. 003140.

In plain English

This 1917 preliminary report described chest X-ray findings in 137 people from dusty jobs. The organic dust groups were tobacco, carpet, plush and silk workers. The inorganic dust groups were cement workers, potters, coal miners and marine firemen, asbestos workers and metal grinders. Each person had a clinical examination, fluoroscopy and stereoscopic X-ray plates. The scanned table is too garbled to tell how many were asbestos workers. The authors described pneumoconiosis in three X-ray stages: thickened shadows near the lung roots, then spotty 'mottling', then diffuse scarring (fibrosis). Mottling appeared somewhat later in potters and asbestos workers than in coal miners, cement workers and certain metal grinders. In cement and asbestos workers the spots were softer and less sharply defined, resembling early tubercles. Cement, asbestos and carpet mills were the dustiest buildings examined. The authors concluded that pneumoconiosis had often been mistaken for tuberculosis. They noted that details from the clinical and X-ray examinations had been compared only in a general way, and that dust volume measurements had not yet been compared.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Preliminary report of a clinical and X-ray (roentgenologic) study of workers in dusty occupations; the report deals only with the X-ray findings
• Who was studied: 137 individuals in various dusty occupations, examined over about a year. Organic dust: tobacco, carpet and plush, and silk workers. Inorganic dust: cement workers, potters, coal miners and marine firemen, asbestos workers, metal grinders. Some were not classified. Subjects came from the Trenton Potteries Company, the Whitehall Cement Works, the Occupational Clinic of the University Hospital (carpet, plush and silk workers) and Dr. J. W. Schereschewsky of the U.S. Public Health Service. The number in each occupation is unreadable in the scan.
• Exposure: Occupational dust inhalation, organic and inorganic, including asbestos workers. Fiber types are not named. Dust volume was measured by Dr. Miller, but no comparisons were reported.
• Main results:
  • The authors described three X-ray stages of pneumoconiosis: increased hilus shadows and thickened trunk shadows; mottling; and diffuse fibrosis.
  • Mottling (second stage) occurred comparatively early in coal miners, cement workers and certain metal grinders, somewhat later in potters and asbestos workers, and quite late in those inhaling organic dusts.
  • In cement and asbestos workers the spots were noticeably softer and less sharply defined than in metal grinders, and looked more like the early individual or conglomerate tubercle.
  • Cement, asbestos and carpet mills were the dustiest buildings examined by Dr. Miller.
  • The density of the X-ray changes was more or less related to the dust inhaled: least in organic dust and greatest among metal grinders.
  • In the authors' experience, the quality of the dust, and probably its weight or density, mattered more than its quantity.
  • The authors invariably found mottling first appearing in the right lung.
• The authors' conclusion: The authors concluded that their studies convinced them that pneumoconiosis and tuberculosis had been confused in diagnosis with considerable frequency, and that telling the two apart was sometimes well-nigh impossible.
• Limitations the authors state:
  • This was a preliminary report. The details brought out by the clinical and X-ray examinations had not yet been compared, except in a general way.
  • Dust volume had been measured, but comparisons had not yet been made.
  • Some X-ray readings recorded as suspicious had not yet been checked against the clinical findings.
  • The authors were uncertain about the X-ray appearance at the transition from the second to the third stage.
  • The authors could often not rule out that shallow diaphragm movement was due to habit or to the person's inability to breathe as instructed.

Topics

Medical terms in this study, explained in our Lexicon: Chest X-Ray, Pneumoconiosis, Fibrosis.

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