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Pulmonary Abscess Secondary to Pneumonokoniosis (Silicosis)
DLSEASES OF THE CHEST
1938
Pulmonary Abscess Secondary to Pneumonokoniosis (Silicosis) Report of Case; and Bronchoscopic Treatment with Recovery. William B. Faulkner, Jr., M.D.* Reynold J. Ferrari, M.D. Joseph Biernoff, M.D. San Francisco, California
is consid-
gative
for tubercle bacilli. THOUGH pulmonary abscesspneumonoRoentgenogram:A cavity with a fluid level of complication Aereh a rare cases came to our attention was noted in the peripheral portion of the i three
-
months. One of these is here- left upper lobe; and scattered throughout reported because it is of interest from the lung fields was a diffuse nodular fibrosis.
intherapeutic,
medicolegal, and industrial Diagnosis: Pneumonokoniosis and superimposed pulmonary abscess. (Fig. 1, page 15). standpoint. History. Case Treatment. 55 year old Italian who The patient was a moldWeighing all the factors involved in this had worked continuously as a "bench paid little case, bronchoscopy had years, 16 and past and postural drainage aper" for the thick, black mucus peared to offer most in the way of therapy. or no attention to the he was expectorating and blowing Proper postures instituted every two
which
from his nose. His present illness came on suddenly with severe dyspnea, weakness, dry hacking cough, slight general malaise, and pain in the left chest and shoulder. Within a week, the symptoms became so pronounced that he was forced to quit work and consult his family physician who diagnosed and treated the condition as influenza. At the end of the seventh week he was admitted to the hospital because he was coughing incessantly and expectorating one ounce of dirty-grey, foulsmelling material. On examination the upper anterior portion of the left chest was immobile. And high 111 the left axilla,below the outer half of the clavicle, there was flatness with absence of actlle fremitus, breath sounds, voice sounds, rales. The left lower lobe showed a slight of resonance and diminution of ath sounds as well as rales and rhonchi W6re audible on inspiration and exPirat 10n The right lung was comPensatory; evide cc of cardiac abnormality was lacking; ana fingers were not clubbed. Temperatvrc S 10°; Pulse 105; and respirations 25. S
w^
* J
Putur^ examinations were
consistently
ne-
Wt*l, San r,° racic Surgical Department, St. Mary's n Prancisco, California.
were
hours; and throughout the course of the illness, fifteen bronchoscopic treatments were administered. In addition, the patient was
given one blood transfusion and three injections of neosalvarsan. Result: The abscess began to drain adequately following the first bronchoscopy, and the patient expectorated sixteen ounces of putrid pus in 24 hours. On the eleventh hospital day, after the fifth bronchoscopic treatment, the pulse rate was 80. Four days later the temperature was normal. expectoration By the seventh week, the ounces, the patient 2y 2 having decreased to hospital and taking the leaving insisted on Here his progat home. his postural exercises expectoration the ress was satisfactory and Then progressively diminished for one month. fever, was There he had an exacerbation. cough. malaise, chest pain, and persistent amount, in increased Even the expectoration and the foul odor reappeared.
and treatA bronchoscopic examinationImmediately
once. ment were instituted at relief. The thereafter he experienced definite teaspoonto one reduced 24 hour sputum was daily. From times to three ful and the cough rapid, and was improvement that point on, clinical was neither within four weeks there 13
DISEASES OF THE CHEST the pulnor roentgenological evidence of monary abscess (Figs. 2 and 3, page 15).
FEB*tiAfiv Summary.
°
One case is reported of a lun abs ess secondary to pneumonokoniosis in year old iron molder. The abscess Discussion. after fifteen bronchoscopic treatments Any one who visits a foundry in the late Despite the contestations of the in is being carrier, The California Industrial SUrariCe afternoon when the molten metal is A poured cannot help but note that the air 6111 Commission recognized the particles, rela~ fully laden with smoke and fine tionship of the abscess to the p neu 0 head to koniosis, and that the men are covered from and awarded a decision in These foot with a grimey black material. the patient while the pneumonokoniosis dusts, being inhaled by the molders, cause still in a comparatively early stage. : irritation of the bronchi and lungs. This decision of the commission In this respect, black "molder's graphite" keeping with the most advanced type was 0f n upon the is the chief offender. It is used medicine, making it unnecessary ventive f day molds innumerable times throughout the the patient to return to his former haza seriouscoughing. The invariably causes and dous occupation, and allowing him to reha ness of inhaling the "graphite" can be ap- bilitate himself before becoming completely preciated when one realizes that it is not incapacitated. graphite, but rather the trade name for a Conclusions. mixture which, in addition to other ingre1. Molding is an industrial hazard. dients, contains silica and carbon. 2. Molder's graphite, which is used in this The perniciousness of the silicosis, which ensues, is universally recognized,but that of work, contains silica and carbon, and prothe anthracosis is not so fully appreciated. duces pneumonokoniosis. 3. Pulmonary abscess is a more common White2 says that with anthracosis, the death rate from pneumoniais nearly twice as great complication of pneumonokoniosis than the medical literature indicates. as where anthracosis is not present. These dust diseases, by blocking the pul4. These complicating abscesses should be lymphatics, leave their victim susclassified monary as industrial and compensable. ceptible to acute respiratory infections which References. are often stubborn and prolonged. The frequency of pulmonary complications is en- 1. Rosenthal, Georges: De la Broncho-pneumome Gangreneuse dcs Pneumonokonioses.Etude clinique hanced, and the patient is less likely to rese bacteriologique. La Presse Medicale de Paris. 10:833, 1902. cover than are people without pneumono2. White, William Charles: Diseases of Dust Inhalakoniosis. tion, Nelson Loose-leaf living Medicine, Vol. 3, 48 w.
healed
industrial
fay^*
*
»♦«
Necessity is Mother of Invention "D^
When the Sussex County Healthc partment of Virginia was establish rec April, 1936, it promptly was WV ■ w that pulmonary tuberculosis stilthai j of the outstanding problems in :
_
y diction. The deaths during that ana Crowded taled twenty-three. of tary living conditions and #"<> tune of the cause and control ' coupled with a lack of funds trUC tive a played important parts in the cou power of this disease in that Pl Funds were insufficient to P natoria,. sta the in open active cases Conse even had ample facilities eXlf!mall one& ereci to quently, it was decided rf t 8, room portable screened coi 'f T ulletin. Bui Burr type. -Va. Dept. Health
an2
DISEASES OP THE CHEST
FIG. 1 Peripheral Lung Abscess Secondary to
.
Pneumonokoniosis
(Roentgen interpretation by Dr. John O'Neill)
FIG. 2 Chest Film After Bronchoscopic Treatment. The fibrosis and mottling of the pneumonokoniosis persist. S-Horizontal scar at site of former abscess. (Compare with Figure 3).
FIG. 3. Film Made in Horizontal Position S-Scar of healed abscess.
1938
Pulmonary Abscess Secondary to Pneumonokoniosis (Silicosis) Report of Case; and Bronchoscopic Treatment with Recovery. William B. Faulkner, Jr., M.D.* Reynold J. Ferrari, M.D. Joseph Biernoff, M.D. San Francisco, California
is consid-
gative
for tubercle bacilli. THOUGH pulmonary abscesspneumonoRoentgenogram:A cavity with a fluid level of complication Aereh a rare cases came to our attention was noted in the peripheral portion of the i three
-
months. One of these is here- left upper lobe; and scattered throughout reported because it is of interest from the lung fields was a diffuse nodular fibrosis.
intherapeutic,
medicolegal, and industrial Diagnosis: Pneumonokoniosis and superimposed pulmonary abscess. (Fig. 1, page 15). standpoint. History. Case Treatment. 55 year old Italian who The patient was a moldWeighing all the factors involved in this had worked continuously as a "bench paid little case, bronchoscopy had years, 16 and past and postural drainage aper" for the thick, black mucus peared to offer most in the way of therapy. or no attention to the he was expectorating and blowing Proper postures instituted every two
which
from his nose. His present illness came on suddenly with severe dyspnea, weakness, dry hacking cough, slight general malaise, and pain in the left chest and shoulder. Within a week, the symptoms became so pronounced that he was forced to quit work and consult his family physician who diagnosed and treated the condition as influenza. At the end of the seventh week he was admitted to the hospital because he was coughing incessantly and expectorating one ounce of dirty-grey, foulsmelling material. On examination the upper anterior portion of the left chest was immobile. And high 111 the left axilla,below the outer half of the clavicle, there was flatness with absence of actlle fremitus, breath sounds, voice sounds, rales. The left lower lobe showed a slight of resonance and diminution of ath sounds as well as rales and rhonchi W6re audible on inspiration and exPirat 10n The right lung was comPensatory; evide cc of cardiac abnormality was lacking; ana fingers were not clubbed. Temperatvrc S 10°; Pulse 105; and respirations 25. S
w^
* J
Putur^ examinations were
consistently
ne-
Wt*l, San r,° racic Surgical Department, St. Mary's n Prancisco, California.
were
hours; and throughout the course of the illness, fifteen bronchoscopic treatments were administered. In addition, the patient was
given one blood transfusion and three injections of neosalvarsan. Result: The abscess began to drain adequately following the first bronchoscopy, and the patient expectorated sixteen ounces of putrid pus in 24 hours. On the eleventh hospital day, after the fifth bronchoscopic treatment, the pulse rate was 80. Four days later the temperature was normal. expectoration By the seventh week, the ounces, the patient 2y 2 having decreased to hospital and taking the leaving insisted on Here his progat home. his postural exercises expectoration the ress was satisfactory and Then progressively diminished for one month. fever, was There he had an exacerbation. cough. malaise, chest pain, and persistent amount, in increased Even the expectoration and the foul odor reappeared.
and treatA bronchoscopic examinationImmediately
once. ment were instituted at relief. The thereafter he experienced definite teaspoonto one reduced 24 hour sputum was daily. From times to three ful and the cough rapid, and was improvement that point on, clinical was neither within four weeks there 13
DISEASES OF THE CHEST the pulnor roentgenological evidence of monary abscess (Figs. 2 and 3, page 15).
FEB*tiAfiv Summary.
°
One case is reported of a lun abs ess secondary to pneumonokoniosis in year old iron molder. The abscess Discussion. after fifteen bronchoscopic treatments Any one who visits a foundry in the late Despite the contestations of the in is being carrier, The California Industrial SUrariCe afternoon when the molten metal is A poured cannot help but note that the air 6111 Commission recognized the particles, rela~ fully laden with smoke and fine tionship of the abscess to the p neu 0 head to koniosis, and that the men are covered from and awarded a decision in These foot with a grimey black material. the patient while the pneumonokoniosis dusts, being inhaled by the molders, cause still in a comparatively early stage. : irritation of the bronchi and lungs. This decision of the commission In this respect, black "molder's graphite" keeping with the most advanced type was 0f n upon the is the chief offender. It is used medicine, making it unnecessary ventive f day molds innumerable times throughout the the patient to return to his former haza seriouscoughing. The invariably causes and dous occupation, and allowing him to reha ness of inhaling the "graphite" can be ap- bilitate himself before becoming completely preciated when one realizes that it is not incapacitated. graphite, but rather the trade name for a Conclusions. mixture which, in addition to other ingre1. Molding is an industrial hazard. dients, contains silica and carbon. 2. Molder's graphite, which is used in this The perniciousness of the silicosis, which ensues, is universally recognized,but that of work, contains silica and carbon, and prothe anthracosis is not so fully appreciated. duces pneumonokoniosis. 3. Pulmonary abscess is a more common White2 says that with anthracosis, the death rate from pneumoniais nearly twice as great complication of pneumonokoniosis than the medical literature indicates. as where anthracosis is not present. These dust diseases, by blocking the pul4. These complicating abscesses should be lymphatics, leave their victim susclassified monary as industrial and compensable. ceptible to acute respiratory infections which References. are often stubborn and prolonged. The frequency of pulmonary complications is en- 1. Rosenthal, Georges: De la Broncho-pneumome Gangreneuse dcs Pneumonokonioses.Etude clinique hanced, and the patient is less likely to rese bacteriologique. La Presse Medicale de Paris. 10:833, 1902. cover than are people without pneumono2. White, William Charles: Diseases of Dust Inhalakoniosis. tion, Nelson Loose-leaf living Medicine, Vol. 3, 48 w.
healed
industrial
fay^*
*
»♦«
Necessity is Mother of Invention "D^
When the Sussex County Healthc partment of Virginia was establish rec April, 1936, it promptly was WV ■ w that pulmonary tuberculosis stilthai j of the outstanding problems in :
_
y diction. The deaths during that ana Crowded taled twenty-three. of tary living conditions and #"<> tune of the cause and control ' coupled with a lack of funds trUC tive a played important parts in the cou power of this disease in that Pl Funds were insufficient to P natoria,. sta the in open active cases Conse even had ample facilities eXlf!mall one& ereci to quently, it was decided rf t 8, room portable screened coi 'f T ulletin. Bui Burr type. -Va. Dept. Health
an2
DISEASES OP THE CHEST
FIG. 1 Peripheral Lung Abscess Secondary to
.
Pneumonokoniosis
(Roentgen interpretation by Dr. John O'Neill)
FIG. 2 Chest Film After Bronchoscopic Treatment. The fibrosis and mottling of the pneumonokoniosis persist. S-Horizontal scar at site of former abscess. (Compare with Figure 3).
FIG. 3. Film Made in Horizontal Position S-Scar of healed abscess.