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An unusual type of miliary lung disease
362
[ M a y , 1931
TUBERCLE
TUBERCLE. MAY, 1931.
Aa Unulual Type of Miliary Lung Disease. Two groups of unusual eases of miliary disease of the lung, not ascribable to tuberculosis, have been described from America. One, reported in 1925 [1] consisted of 38 cases selected from about 60,000 X-ray examinations of the chest made in the Mayo Clinic; the other, just reported [21, comprised 125 cases found during routine X-ray examination of 18,285 individuals exposed to an occupational dust hazard. Multiple, miliary, calcified spots were observed on each occasion, varying in size from a pin-point to three microns; they were round, discrete and sharp in outline. They resembled lead shot of about No. 8 size. No clinical syndrome indicative of the anomaly was obtained; but, although in the latter group no history of symptoms was forthcoming in 65"6 per cent. of the cases, 34"4 per cent. spoke of dyspncea, cough and the expectoration of blood-tinged mucus, together with malaise. No characteristic physical signs were detected. Tubercle bacilli were found in the sputum of two out of 88 cases examined, but were otherwise not in evidence. These cases among the industrial group showed no relation to dust exposure, and for the most part were detected on applying for work or soon after. The origin of the condition is somewhat obscure ; but evidence is given in support of the disease being a pneumomycosis. Two types of fungi were detected in the
sputum--Aspergillus famigatus fisheri and Aspergillus niger. Ten cases tested with antigen of Aspergillus fumigatus fisheri gave negative reaction; but six cases tested with Aspergillus niger all gave positive reaction. One thing common to the cases belonging to both group~ is an agricultural exposure to dust arising from grain ; such dust was found to contain fungi resembling those isolated from the sputum. Pneumomy-
eosis due to aspergilli has been described by a number of authors [3] particularly as arising as a trade disease in Paris, among those who feed pigeons artificially with grain held in their mouths, and also those who comb and sort hair. From time to time in this country outbreaks occur among cotton weavers, which have been ascribed [4] to inhaling moulds which, under certain conditions, appear up.on warp threads. The cases develop m epidemics, in weaving sheds where the threads are affected, with rapid breathing and persistent cough, associated with the expectoration of thick yellowish sputum and a sweetish taste. A s t h m a m a y now disturb sleep, and food may be rejected. General malaise is present with slight pyrexia, ending in sweating. Appetite is affected, weight is lost and dyspncea occurs on exertion. The precise mould at fault has not been detected, nor have X-ray examinations been made. These outbreaks may represent tim acute stage of the disease, of which the American descriptions deal with the subsequent history. The tendency for the disease to be confused with early cases of tuberculosis is notable in all instances, and also the tendency to complete recovery. No earlier reporter had X-ray technique at his disposal. Interest would attach to a search for certain of these earlier cases to ascertain whether, on X-ray examination, similar shadows would be found to those reported from America. Possibly else investigations among agriculturists in this country might bring a similar condition to light. Undoubtedly, much work yet remains to be done by routine X-ray examination of the apparently healthy. REFERENCES. [I] SUTHnRLAND, C.G.
"Miliary Calcification
of the Lung." The Medica~ Clinics of North America, 1925. 8, 1273. [2] SAYEBS, R . R . "Miliary Lung Disease due to Unknown Cause." Public Health Reports. No. 49, Washington, 1930. [3] ASLBUTT, C System of Medicine. Vol. 5. London, 1898. [4] COLLIS, E. L. " Unusual Illness among Weavers of Cotton Cloth." 1913. London: H.M. S~ationery Office.
[ M a y , 1931
TUBERCLE
TUBERCLE. MAY, 1931.
Aa Unulual Type of Miliary Lung Disease. Two groups of unusual eases of miliary disease of the lung, not ascribable to tuberculosis, have been described from America. One, reported in 1925 [1] consisted of 38 cases selected from about 60,000 X-ray examinations of the chest made in the Mayo Clinic; the other, just reported [21, comprised 125 cases found during routine X-ray examination of 18,285 individuals exposed to an occupational dust hazard. Multiple, miliary, calcified spots were observed on each occasion, varying in size from a pin-point to three microns; they were round, discrete and sharp in outline. They resembled lead shot of about No. 8 size. No clinical syndrome indicative of the anomaly was obtained; but, although in the latter group no history of symptoms was forthcoming in 65"6 per cent. of the cases, 34"4 per cent. spoke of dyspncea, cough and the expectoration of blood-tinged mucus, together with malaise. No characteristic physical signs were detected. Tubercle bacilli were found in the sputum of two out of 88 cases examined, but were otherwise not in evidence. These cases among the industrial group showed no relation to dust exposure, and for the most part were detected on applying for work or soon after. The origin of the condition is somewhat obscure ; but evidence is given in support of the disease being a pneumomycosis. Two types of fungi were detected in the
sputum--Aspergillus famigatus fisheri and Aspergillus niger. Ten cases tested with antigen of Aspergillus fumigatus fisheri gave negative reaction; but six cases tested with Aspergillus niger all gave positive reaction. One thing common to the cases belonging to both group~ is an agricultural exposure to dust arising from grain ; such dust was found to contain fungi resembling those isolated from the sputum. Pneumomy-
eosis due to aspergilli has been described by a number of authors [3] particularly as arising as a trade disease in Paris, among those who feed pigeons artificially with grain held in their mouths, and also those who comb and sort hair. From time to time in this country outbreaks occur among cotton weavers, which have been ascribed [4] to inhaling moulds which, under certain conditions, appear up.on warp threads. The cases develop m epidemics, in weaving sheds where the threads are affected, with rapid breathing and persistent cough, associated with the expectoration of thick yellowish sputum and a sweetish taste. A s t h m a m a y now disturb sleep, and food may be rejected. General malaise is present with slight pyrexia, ending in sweating. Appetite is affected, weight is lost and dyspncea occurs on exertion. The precise mould at fault has not been detected, nor have X-ray examinations been made. These outbreaks may represent tim acute stage of the disease, of which the American descriptions deal with the subsequent history. The tendency for the disease to be confused with early cases of tuberculosis is notable in all instances, and also the tendency to complete recovery. No earlier reporter had X-ray technique at his disposal. Interest would attach to a search for certain of these earlier cases to ascertain whether, on X-ray examination, similar shadows would be found to those reported from America. Possibly else investigations among agriculturists in this country might bring a similar condition to light. Undoubtedly, much work yet remains to be done by routine X-ray examination of the apparently healthy. REFERENCES. [I] SUTHnRLAND, C.G.
"Miliary Calcification
of the Lung." The Medica~ Clinics of North America, 1925. 8, 1273. [2] SAYEBS, R . R . "Miliary Lung Disease due to Unknown Cause." Public Health Reports. No. 49, Washington, 1930. [3] ASLBUTT, C System of Medicine. Vol. 5. London, 1898. [4] COLLIS, E. L. " Unusual Illness among Weavers of Cotton Cloth." 1913. London: H.M. S~ationery Office.