Mr SAUTREUIL
1 would simply like to refer back to Mrs WANG's speech to say how enriching
it can be-for the western doctor I am and for the other colleagues here
present-to take an interest in traditional. Chinese medicine which to
our mind is above all acupuncture but also the pharmacopoeia. The 'plus'
for a practising physician concerns the analysis of symptoms and treatinent
possibilities.
Mr LAFOREST
A complementary question: the effects of Chinese drugs, and of drugs
used in combination with them, have been spoken of, but you did not
mention the equivalent of a posology. Do you reason in terras of doses,
and how are they are determined?
Mrs WANG
All I can say is that Chinese drugs are classically prepared as decoctions
of dried plants. A decoction is prepared with 3 to 15 grammes per plant
and each formula is différent. The decoction is drunk once in
the morning and once in the evening for 3 or 4 days. Today, with the
new techniques, the compositions are well defmed and depend on the pharmaceutical
laboratory.
Over the past ten years lyophilisates of Chinese drugs with concentrations
of 5%, 10% ... a whole series of productions, have been greatly imported
worldwide. The dose depends...
Mr BONNEVIALE
I would like to give my reaction regarding what Dr WANG said regarding
the personal factor. Some people are believed to be more prone and others
less prone to contracting silicosis. It is my personal conviction that,
if people are exposed to the same amount of dust, they will all fmally
develop silicosis. If some people suffer less from silicosis than others,
it's because they were employed in posts less exposed to silica dust.
I'm not a doctor but, if a personal physiological factor exists, in
my opinion it plays only a negligible role in comparison with the exposure
factor. To return to what Dr MARQUET said at the beginning of the day:
you can't beat prevention at the work place.
Mrs WANG
I agree with you, but nevertheless we see différent progressions
of the disease in différent patients. Some people present fibrous
nodules straightaway whereas others are still at an earlier stage. The
same applies in Chinese medicine. The disease should be prevented before
it develops and any worsening should be avoided. Depending on one's
personal temperament the disease develops at a différent pace.
Mr COCUDE
1 regret that Messrs. MAIREU and AMOUDRU have had to leave us. It would
be necessary to have the opinion of a doctor who has effectively monitored
miners from the Houillères (coalmines). As far as 1 recall, the
doctors at the Houillères-l'm thinking particularly about the
Houillères du Midi, and perhaps also about the Houillères
du Nord-Pas-de-Calais-had observed différences in the developrnent
of pneurnoconiosis, even in the same family between brothers. Obviously,
we would have to have doctors who have effectively monitored families
of miners. In the Nord-Pas-de-Calais department, there were dynasties
of miners, whole families went to work down the mine frorn one generation
to the next.
Mr KOCH
The regulation on pneumoconiosis in coalmines was elaborated with Dr
AMOUDRU some thirty years ago. The aim was that an averagely prone to
silicosis person working in a mine should not catch the disease. Resources
weren't available to prevent and combat dusts in mines to the extent
that there would be nil dust there. The aim was to protect only workers
averagely prone to silicotic dust and it was accepted that some people
are more prone to the disease than others, which is why the regulation
stresses the importance of medical supervision of workers at coalmines.
Mr LAFOREST
I could add that this involves the general problem. of the determination
of limits in occupational diseases, whether pneumoconioses or diseases
caused by toxic substances or allergies. This same problern still arises
today and the limits laid down by the French or international regulations
are still: 'x per cent of the population is protected.'. By the very
setting of limits, it is clearly accepted that some people are more
prone than others. A good example is given by allergy: 2 or 3% of the
population will have acute allergic reactions to certain exposures whereas
95% will not be affected at all. Limit cases, individual proneness,
will always exist, posing a real problem. in preventive medicine.
Mr BONNEVIALE
In my opinion-that of a non-doctor-nobody is totally immune. In some
coal basins the prevalence of silicosis exceeds 50% (in other words,
out of 100 miners, at least half contract silicosis), so why aren't
the others affected? The answer is probably because they were less exposed
in work posts where there was little or no dust.
MrKOCH
Mr BONNEVIALE's remarks do not contradict what I say. I entirely agree:
what applies in rats applies in men-they end up contracting the disease.
INERIS and, before it, CERCHAR, have conducted enough experiments exposing
rats to a very high amount of dust. Even at low exposures a range of
sensitivities is to be found.
Mr COCUDE
There is another question 1 would like to ask, and perhaps Dr LAFON
can answer. In your dossier you have seen the stages, or more exactly
the levels, of pneumoconiosis according to Chinese clinical practice;
I'm referring to the document by Mrs WANG and Mr DUHAMEL, entitled "Pneumoconiosis
in Chinese medicine" and which addresses clinical practice.
1 read ... first level ... dryness of the lungs, with the description
of a certain number of points: dry cough, little phlegm, etc ... ; second
level ... cough with thick phlegrn or phlegra mixed with blood, chest
oppression etc ... ; third level ... cough with expectoration of blood,
breathlessness worsened by movement, weariness, asthenia.
Mr LAFON
It's very difficult to reply. Admittedly, in clinical practice a certain
number of factors are found classically: an increase in symptoms and
a beginning with a dry cough, the appearance of phlegrn-all of that
is the normal development of pneumoconiosis. In contrast, when the appearance
of blood is seen, when the general state of health worsens, it is perhaps
the normal development of pneumoconiosis, but it may also represent
the appearance of tuberculosis, or that of associated pathologies. How
does tuberculosis fit into this context since it is managed with very
specific treatments?
Mr DUHAMEL
No specific answer can of course be given. We have received information
from China without being really specialists ourselves. Apparently the
secondary disorders at the end of the experimentation are distinguished
from the bacterial disorders following pneumoconiosis. If we were interested,
we would have to contact the people who are effectively conducting these
studies on thousands of cases, and we would have to address the matter
in greater depth. 1 think the subject is worth it.
Mrs WANG
In Chinese medicine some symptoms are very important in diagnosing
and in prescribing drugs, whereas other are not.
Another point also is that in Chinese medicine patients are constantly
monitored and X-rayed regularly. Monitoring and x-raying are used in
conjunction and even in tuberculosis. The Chinese medicine formula does
not change. On the other hand, more or less elements are added in the
compositions between the first and the second stage because there is
no distinction between tuberculosis and fibrosis as regards their symptoms.
X-raying shows the différence.
Mr COCUDE
We are now going to conclude. 1 am asking Mr OBRINGER to conclude the
debate on the pharmacopoeia for the same reason which made me ask Mr
KOCH to conclude the debate on acupuncture-they both have an impartial
view of the subjects discussed.
