The lipoid pneumonia of blackfat tobacco smokers in Guyana

In Guyana, a large number of patients have been diagnosed as having a diffuse pulmonary fibrosis of unknown aetiology, characterized by typical radiological appearances, dyspnoea, cough, weight loss, and eventually pulmonary heart disease. Investigation of 56 patients showed that all had smoked a tobaco known as 'blackfat' or 'black tobacco'. In a community survey 20.4 per cent of the population aged 55 years and over smoked this tobbaco. 19.6 per cent of the blackfat smokers but no non-blackfat smokers showed definite radiological evidence of pulmonary fibrosis. Smokers with, but not those without fibrosis, had severe airway obstruction. Immunological studies made it unlikely that an extrinsic allergic aveolitis had caused the radiological changes. Three post-mortem open-lung specimens were obtained and in each case the histology showed a diffuse interstitial fibrosis and vasculitis associated with large deposits of lipid surrounded by black amorphous material. Blackfat is a tobacco leaf to which mineral oil and vaseline is added for flavouring and as humectants. The presence of oil in the tobacco, and the post-mortem findings of oil in the lungs, indicate that the diffuse pulmonary fibrosis can be more accurately described as a lipoid pneumonia caused by the inhalation of mineral oils when blackfat is smoked. The potential health hazards of many tobacco additives, particularly oils, employed by the tobacco industry should be recognized. A similar type of disease as that found in Guyana may be present in other parts of the world where blackfat, or related tobacco, are smoked.(Summary)

A comparison of T-wave inversion, S-T elevation, and RS amplitudes in precordial leads of Africans and Indians in Guyana

ECG precordial leads of 830 Guyanese men and women of African and Indian origin, aged 35-54 years, were compared. The prevalence of nonupright T waves in right precordial leads (V1 to V2) were similar in the two ethnic groups. T-wave inversion in V1, V2 and V3 was present in 46.4 percent, and 2.4 percent of women, respectively, compared with 9.6 percent in V1 and no inversion in V2 and V3 in men. S-T elevation occurring in any of the precordial leads was present in 2.1 percent of African women, 0.9 percent of Indian women, 18.1 percent of African men, and 13.6 percent of Indian men. Neither T-wave inversion in the right precordials nor S-T elevation were associated with detectable clinical abnormality, hypertension, obesity, or raised blood cholesterol levels and both appeared to be normal variants. S-T elevation was associated with large QRS complexes. Mean amplitudes of S waves in V1 and R waves in V5 and V6 were significantly greater in men than in women and in Africans than in Indians. These differences could only be partially explained by variations in age, blood pressure, obesity, or cardiothoracic ratios. Possible ethnic and sex differences in the prevalence of T-wave inversion in right precordial leads, S-T elevation, and high amplitude QRS complexes can be of clinical and epidemiological importance (Summary)

Ethnic variation in forced expiratory volume and forced vital capacity of African and Indian adults in Guyana

In Guyana, forced expiratory volume in one second and forced vital capacity were measured in 96 African men, 109 African women, 129 Indian men, and 99 Indian women between 35 and 54 years old. No subject had evidence of any disorder that might have impaired ventilatory capacity. Indians of both sexes had significantly smaller values by approximately 4 percent to 7 percent than Africans, and both groups had smaller values than those quoted for white persons. These differences remained significant after standardization for age and body size. The forced expiratory volume and forced vital capacity values of the subjects are described as multiple regression equations on height and age.(Summary)

Characteristics relevant to cardiovascular disease among adults of African and Indian origin in Guyana.

Characteristics relevant to cardiovascular disease, including anthropometry, arterial blood pressure, serum cholesterol levels, chest radiography and electrocardiography, were investigated in a survey of 843 men and women aged 35-54 years of African and Indian origin living in 2 communities in Guyana. Clinical experience suggested a high incidence of hypertension and a low incidence of ischaemic heart disease.Africans were taller and heavier than Indians but their other characteristics were, in general, similar except that their mean blood pressure levels and R amplitudes in certain ECG leads were consistently higher. Hypertension was common and was significantly correlated with obesity and, probably independently, with body size. Serum cholesterol levels, with mean values of about 200 mg/100 ml, were strongly correlated with factors associated with obesity in men but not in women. Cardiothoracic ratios, measured from chest films, were greater than values regarded as normal for Europeans because of a relative narrowness of thoracic diameters.Prevalence of S-T-segment and T-wave defects in ECGs classified by the Minnesota Code was as high as reported from communities where ischaemic heart disease is clinically more frequent. Hypertension, cardiac enlargement, obesity and cholesteraemia were more prevalent when defects involved lateral leads (I, aVL, V5 and V6) than in subjects with normal ECGs, suggesting that the majority of important abnormalities occurred primarily in the left ventricle and were probably related to hypertension rather than to coronary insufficiency without hypertension. Analysis of S-T and T-wave defects, both by blood pressure and by lead position, might show meaningful differences between populations which, by present methods of presentation, appear to have surprisingly similar prevalences of ECG abnormalities.

Characteristics relevant to cardiovascular disease among adults of African and Indian origin in Guyana

Characteristics relevant to cardiovascular disease, including anthropometry, arterial blood pressure, serum cholesterol levels, chest radiography and electrocardiography, were investigated in a survey of 843 men and women aged 35-54 years of African and Indian origin living in 2 communities in Guyana. Clinical experience suggested a high incidence of hypertension and a low incidence od ischaemic heart disease. Africans were taller and heavier than Indians but their other characteristics were, in general, similar except that their mean blood pressure levels and R amplitudes in certain ECG leads were consistently higher. Hypertension was common and was more significantly correlated with obesity and , probably independently, with body size. Serum cholesterol levels, with mean values of about 222mg/100ml, were strongly correlated with factors associated with obesity in men but not women. Cardiothoracic ratios, measured from chest films, were greater than values regarded as normal for Europeans because of a relative narrowness of thoracic diameters. Prevalence of S-T-segment and T-wave defects in ECGs classified by the Minnesota Code was as high as reported from communities where ischaemic heart disease is clinically more frequent. Hypertension, cardiac enlargement, obesity and cholesteraemia were more prevalent when defects involved lateral leads(I, aVL, V5 and V6) than in subjects with normal ECGs, suggesting that the majority of important abnormalities occurred primarily in the left ventricle and were probably related to hypertension rather than to coronary insufficiency without hypertension. Analysis od S-T and T-wave defects, both of blood pressure and by lead position, might show meaningful differences between populations which, by present methods of presentation, appear to have surprisingly similar prevalences of ECG abnormalities.(AU)

Diffuse pulmonary fibrosis and blackfat tobacco smoking in Guyana - abstract

Over the past year epidemiological, immunopathological and morbid anatomical studies have been in progress in an attempt to define the aetiology of an obscure form of diffues pulmonary fibrosis in Guyana. Dr. H. M. S. G. Beadnell of Lusignan hospital has kept a record of all cases of pulmonary fibrosis referred to him. 14 of these patients were interviewed and examined. All were Indian aged 49-75 years, and 9 were women. The onset had been insidious, there being progressive dyspnoea, dry cough and weight loss. Common findings were central cyanosis, basal crepitations and signs of right ventricular hypertropy. Chest X-ray showed diffuse fibrotic changes and areas of consolidation. Lung function showed severe obstructive airways disease in most, and restrictive lung disease in a few. Patients were questioned about previous occupations, dust exposure and smoking habits. This revealed that all smoked blackfat tobacco smoking was determined during a population survey of two local communities. Only eleven blackfat tobacco smokers were found, all Indian women, and three of these had typical pulmonary fibrosis. 16 people known to smoke blackfat tobacco were examined; 12 had evidence of respiratory disease and 5 had radiographic appearances of pulmonary fibrosis. Further epidemiological studies undertaken more recently lend support to these findings(AU)

VDRL tests in representative communities of Guyanese adults

VDRL tests were carried out on 774 adults aged 35-54 years in two typical African and East Indian communities in Guyana. Results were weakly reactive in 11.2 per cent. at reactive in 6.9 per cent., the reactivity rate being higher in Africans than in East Indians. Reactivity was not due to previous infection with yaws which has been absent from most of Guyana for many years in contrast to some parts of the West Indies. Clinical evidence of syphilis in Guyana is surprisingly infrequent in view of the high reactivity rates. (AU)

Anthropometric measurements of Guyanese adults of African and East Indian racial origins

Anthropometric measurements were made of Guyanese men and women aged 35-54 years of African and East Indian origin living in adjacent communities. Africans were taller with greater shoulder widths and slightly smaller hip widths than East Indians. Africans men had larger upper arm circumferences and smaller triceps skinfolds than East Indians, an indication of greater muscular development. The relative leg length and ratio of the lateral to the antero-posterior diameters of the thorax were similar in the two races. The difference in size was less between male and female Africans than between male and female East Indians. Obesity was common in women of both ethnic groups, a feature which often occurs in emerging countries and which may lead to an increase in the incidence of conditions such as hypertension and diabetes. (AU)

Diffuse pulmonary fibrosis and blackfat-tobacco smoking in Guyana

The clinical features and epidemiology of diffuse pulmonary fibrosis in Guyana have been investigated. The condition is limited to East Indians and is characterised by progressive dyspnoea leading to pulmonary heart-disease and congestive heart-failure. 19 hospital patients studied, and 7 others radiographically confirmed, had all smoked "blackfat" tobacco, a variety which is not widely used.(Summary)

Industrial injuries in the sugar industry of British Guiana

An outline of the incidence and nature of industrial injury among sugar workers in British Guiana is given, and some of the medical and therapeutic, administrative and legal, difficulties met with in dealing with this problem are described. No original observations are made; the purpose of the paper being to draw the attention of the profession in the Caribbean to a problem hitherto of minor importance, which is likely to increase in the future. (AU)

Eight years experience with injuries and workmen's compensation in the sugar estates of British Guiana (abstract only)

On a group of sugar estates having an average daily labour force of 3,400, over the period 1953-1959, a total of 14,493 injuries at work claiming to be entitled to workmen's compensation, have been reported. Of these 80 percentreceived workmen's compensation. This resulted in the loss of 225,805 working days or 1 day lost for every 381/2 man-days worked and to an average of 91/2 days per year for each worker employed (AU)