Papers - Health and Safety in Mines - Diagnosis of Silicosis (Abstract)

Both history and physical examination are unreliable in the diagnosis of silicosis. In some studies 25 per cent of individuals with silicosis have been found to have no symptoms whatever. The positive physical findings that may be produced by this disease include diminished chest expansion, diminished lung resonance, distant and harsh breath sounds. However, many workmen of a short stocky type have diminished chest expansion without any lung disease. In a study of rockdrillers made by the author more than half of the men without silicosis were limited in chest expansion to 2 in. or less instead of the "normal" 6. In a study of stonecutters the average chest expansion in the negative group was found to be only 2.4 inches. Changes found upon physical examination of the lungs themselves are so inconstant as to be of little diagnostic value. In the studies of rockdrillers and stonecutters already referred to, approximately 25 per cent of those with advanced silicosis apparently had normal lungs. The usual functional tests of lung performance are likewise of little value because of marked individual variation. Average vital capacity will be reduced in a group of silicotics below what might be expected in a group of normals, but certain individuals of the former group may have an entirely vital capacity, giving no indication of the underlying presence of silicosis. It follows that the X-ray examination is absolutely indispensable in the diagnosis of this disease. X-ray findings characteristic of silicosis have been described innumerable times. They consist essentially of a mottling of the lung fields due to the presence of fibrous nodules which develop as a reaction to the presence of the irritant silica.