[The need of a young physician for insurance].
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The history of pneumoconiosis research in Switzerland from the 16th century to the present day is briefly summarized. The concerns and aims of a silicosis research group founded at the end of World War II by faculty members of Zurich University, Federal Institute of Technology (ETHZ) and by the SUVA (Swiss national accident insurance) are presented. The salient results of interdisciplinary research on the pathogenicity of particle size and fibrogenicity of various mineral and non-mineral dusts are discussed, and related questions of cancer epidemiology are considered.
The effects of noise on health can be divided into aural effects and extraaural effects. The following review describes - after some historical remarks - first the physical and technical basis of noise analysis. The definition of "equivalent continuous sound level" (Lm) and "rating sound level" (Lr) is given. Extraaural noise effects mainly come from the environment (traffic noise, construction noise on building sites). One must distinguish physical and vegetative reactions. An important extraaural effect is the disturbance of sleep. The objectivation and quantification of extraaural effects of noise on health is very difficult because there exist a lot of disturbing factors. The most important aural effect of noise on health is the occupational hearing loss. To assess these effects, information about physiology, pathophysiology and clinical indications of noise induced labyrinthine deafness is necessary. As examples results of investigations into the effect of noise on arc welders, professional musicians and building workers are presented. Generation of noise should be minimised by technical methods, exposure to noise by personal protection. The methods for occupational medical check-up of the employment accident insurance fund are specially mentioned. The results of these preventive procedures can be seen in the decreasing numbers of occupational hearing loss.
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The clinical signs and symptoms of health hazards caused by wood are discussed together with their etiology and pathogenesis. 165 such cases were reported to the SUVA (Swiss Accident Insurance Association) up to the end of 1978. Disorders were most common among workers having the greatest exposure to the fine wood dust produced by tropical woods (in particular during grinding and cutting processes). 130 patients suffered from allergic contact eczema or non-allergic contact dermatitis. 35 patients suffered from respiratory tract disorders, 12 of these being classic bronchial asthma. Reference is made to the literature which points to the sharply increased incidence of adenocarcinoma of the paranasal sinus after long-term exposure to wood dust.
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The great increase in the number of persons engaged in sports in the 30-50 years age group has led to a marked increase in injuries of the tendon of Achilles. In this case there is tearing loose of the Achilles tendon; the bone and the tendon come apart, as in a rupture of Sharpey's fibres. The tack was made in webbing the tendon of Achilles with polydioxanone ligaments to the tuberosity of calcaneus. The question about prophylactic webbing of the degenerated tendon of Achilles on the other side has to be discussed. Assessment of this injury from the viewpoint of the accident insurance company is explained.
Until the 1930s all meniscal lesions were considered to be of traumatic origin. The efforts of Magnus and his pupils led to a more differentiated medicolegal interpretation of wear and tear of the meniscus and classification of at least some types of meniscal lesions as nontraumatic in the sense of accident insurance. This caused controversy, continuing to the present day, as to whether trauma or degeneration is essential for a meniscal tear. This debate can now be closed. Numerous investigations of meniscus pathology have proved that the isolated, essentially traumatic meniscal tear does not exist. Only if the viscoelastic properties of meniscus tissue are changed may indirect force cause a rupture. There is no longer any reason to follow principles for the assessment of meniscus damage differing from those for tendon or intervertebral disc lesions. Only penetrating joint injuries or joint fractures may lead to a direct meniscal lesion (corresponding to penetrating spine trauma or vertebral body fracture with concomitant disc lesion). Separation of the meniscus from its insertion is the analog of discoligamentous spinal trauma. Post-traumatic meniscus degeneration due to joint instability is equivalent to the instability of the motion segment with intervertebral disc degeneration. Isolated meniscal tears and isolated intervertebral disc ruptures cannot be caused by indirect force. The conventional, inconsistently applied criteria to distinguish traumatic and degenerative meniscal lesions are no longer necessary.