Document 061xX0Dq6y3QKq7gQD6nnYBRn

FILE NAME: Sprayed Asbestos (SPRA) DATE: 1961 Aug DOC#: SPRA015 DOCUMENT DESCRIPTION: Medical Journal Article - Asbestosis in a Worker Engaged in Automobile Undercoating MEDICAL INTELLIGENCE -- BRl'GSCH AND BAVLEY 379 Nc 8 medical intelligence monarv fibrosis. T w o wedge biopsies from the lin gula and the lower lobe showed, microscopically, m any areas of foreign-body reaction as w ell as a few typical asbestos fibers. #1? . w v. 3~-. i.* '. ^ : '>.A T he foreign-body reaction appeared most marked *ro" areas that stained blue and contained unidentifiable ho mogenous material. Marked connective-tissue reaction was present. There was no evidence of cancer, tuberculosis or 5BEST0SIS IN A WORKER ENGAGED IN AUTOMOBILE UNDERCOATING H e i n r i c h G. B r u o s c h . M.D.,* a n d H a r o l d B a v i .e y , B.S., C h . E . | BT h eV alien t made an uneventful recovery, his fever sub sided and he was discharged on January 9 greatly improved. H e continued to have some greenish tenacious sputumi an slight shortness of breath, w ith wheezing. H e r^ urne^ work to the same company and was assigned as a par s distributor in the Service D epartm ent Cht re-examination he still had a moderate cough, with slight dyspnea on exertion, 12 m onths Inter. The occupational history revealed that this man b o sto n was engaged in his present occupation at the same company as an automobile mechanic for ten years. 'HE term pneumoconiosis applies to diseases of Previously, he had worked for two years at a saw ;the lungs caused by inhalation of foreign ma- manufacturing company, where he operated a cold Hl. A more specific diagnosis will depend upon press, and before this he had worked at a gasoline sta hect identification of noxious substances in air tion.'H e had a complete physical examination, in nples, SDutum and, whenever possible, lung tissues, cluding a chest film, which was interpreted as nor cons 'the occupational hazards causing penumoco- mal, when he was first hired ten years before ad osis.Vsbestos has been identified in exposed mine mission to the hospital. jrkers. v.oikers handling insulating materials com- His work consisted of the servicing of new automo sed lamely of asbestos, workers in the brake-lining biles, essentially from one American car manufac jjustrv and workers engaged in asbestos spinning, turer. . . 'ding and weaving.1 Although asbestos bodies ha\ e With the exception of fiberglass in small quantities, n found in the lungs or sputum of patients with no material of significance in occupational diseases evidence of pulmonary disease or heavy exposure, ie presence of asbestos bodies in the lungs of^ a irker :r. an occupation hitherto not connected with >estcv makes the following case worth reporting. was used by this worker in his job. In addition to his routine duties for the last six years he had been engaged on a contract basis in applying an asbestos-base undercoating on new cais. C ase R eport This operation was performed in a wing of the garage measuring 15 by 26 feet and closed at both F.T .. 41-year-old autom obile m echanic, was admitted to [ho'pitV- in the vicinity of Boston on Decem ber 15, 19o8, 1th a:, a: ite febrile disease. H e com plained of cough shortss of 0 eath and yellow ish expectoration. H e had been urm: several weeks previously, w hen he had noted the radual -.set of productive cough, w eight loss and excessive iligne rOn acrr.ission he was febrile and coughing. T he temper- bare \sa; m oderateiy elevated. O n physical exam ination iere wa: a congenital anom aly of the right arm and cyano'.' of the ears." Rales and rhonchi were present over dth lur.a = There was no clubbing of the fingers. Laboratory fcud'es 5. .wed "yeastlike bodies" in the sputum. Gastric psliir.e:- ...ere negative for acid-fast bacilli, and a Papanico- fju ,7 was negative for m alignant cells. Blood studies *Aed a hematocrit of 47 per cent, a white-cell count of fp.800. .:h 72 per cent neutrophils, and a sedim entation kte ot .' ~.rrt. per hour. A tentative admission diagnosis of hetm-v 'is was made. ., , , ,, fX-ra. -'-as taken on the follow ing day showed diriuse {Rarcral - V.t-ation of the lungs by m inute, discrete nodular nsitlr5 ard considerable accentuation of the peribronchial feruas; is markings, particularly of the lower lobes. T he prdia' - ' lours wore not clearly defined, being partially a the infiltration. There was considerable bi- ^'trai - ' *opathy. , , . r. A fc:, - j>COp> and broncho-jrapny pf-xtoimed on lJc 'nIotHwVel.dLj "tUrUacVhi leWobVriovnx vch. .i--t-i-s--." Thoracotomy in tb.e ; left lingula on January 5, 1959, revealed that >.ad a fine, granular appearance, suggesting pul- rofrwii of medium-, lu lls University School of Mcthcn.e phvsician, Masqat husc os D epartm ent ot Labor ami . ,,ei-i, Massachusetts D epartm ent of Labor ami Indi.M i.i- ends by wide sliding doors, which permitted the en trance and exit of automobiles. There were large windows at one side of this wing. I he undercoating operation was carried out by means of a hand-type spray <mn operated at a pressure of 110 pounds per square inch and directed against the underside of the raised car. No mechanical ventilation and no respiratory protective devices were in use during this operation. A considerable amount of the tarry asbes tos-base material was dispersed through the work area and onto the worker's clothes and face. The un dercoating material was pumped from a 55-gallon drum. Each car required approximately 4 gallons^ of the material and thirty to sixty minutes of spraying time. About 1 to 3 cars were sprayed daily by the patient daring the first five years, and less during the last year. Since the illness suggested the possibility that the undercoating of automobiles was responsible for or contributory to the acute pulmonatv disease, it was deemed advisable to investigate the undercoating operation presently performed by many automobile sales and service agencies in Massachusetts. To obtain background information, contact was made with the industrial-hygiene units of the large automobile as- th v.Vi 265 No. 8 MEDI CAL IX'I EEEIGEXGE 1 ERRIS ET Al. 881 wvuomic findings, Tim material that the patient as'il contained asbestos of various filler sizes in an imhalt base and was held in a mastic form by a sol vent of the petroleum-distillate t\pe. Jaing biopsy revealed the presence of asbestos bodies of chaiacternnc appearance. I he unusual finding in this case e .s the presence of numerous amoiphous bluish- woikeis with [)i olonged and continuous exnosuie to ibis opemlion are made A c arc indebted to R E I 'a n a n d . M D . oi 1 pc hbuig ioi permission to repoit this caw am! lo II J Sparling'. M D . pathologist, Burbank Hospital. F i t th h u r a fur* it view I Pit* pathological specimens staining deposits fairly widely dispensed throughout R eferences ire specimen and surrounded by mflammaton and ..o:mcctnolissuo lcaclion. I ho x-inv appcrtrmicc v finely granular infiltration throusrhout both lower eves and the possibility that the sputum abo con ' ! < n t " p ^ M `SCaUS ccut,a,wns m q I'l' -Dmon I.m!< Brown, 1 H o h P r Pmumocnmosis: Industnal illumes . / ii.e Urn- c auud m fin t 2b8 p p Lo n d o n Am.old 1937 P. ] i 3 * " fined asbestos bodies ('Voastlike bodies' ) indicate rhac the lung process in this man was of a chronic emire consistent with pneumoconiosis and the di rect local action of foreign materia! such as asphalt a.-.u asbestos. This is also suggested by some of the M tests obtained in the survey. NEPHROTIC SYNDROME CAUSED BY PR O B E N E C ID " T homas F F erris, M .D ..t W vlter S. M o r g a n . M .D..t and iwom the point of view of occupational health it H oward L evi tin. M .D. -- significant that the patient, in contrast to the . meets onsets cd in the siuvcy, had been daily and N E W H A V E N . C O N N F.i'.TTCU [' continuously engaged in the underroating operation r- mote than five soars, that no historv of previous .eng disease or exposures to noxious material could fir demonstrated and that the survey had shown mat the spraying proceduie was accompanied bv .ermclet able back splash into the breathing zone of the worker. ' HE nephrotic syndrome lias been reported to oc' ' cur in the course of therapy with a number of drugs including trimethadioneT; paramethadionek m eicuiul aiuietics,4 tolbutamide" and pcrclkoratek as wei! as in association with semitivitv to poison oak; and bee sting.8 ! he cross-sectional suney here icpoited indicates m.at under prevailing methods of operation, the use ,.n asbestos-base undcrcoating, when limited to wort exposures, lias not resulted in an occupational i.azatd. However, if this operation is performed conhnrously without adequate ventilation and protecU'Je respiratory equipment it may expose the worker .o trie potential danger of pneumoconiosis. As a protective measure, it is therefore recommend In the case repoitcd below, trie nephrotic syn drome appeared to be the result of a reaction to probenecid/ Although proteinuria and renal failure are known to occur in the course of chronic sjout, the nephiotic syndrome has not heretofore been reported as a result of gouty nephritis or in association with piobenecid therapy. C ase R eport ed that workers using asbestos-base undercoating i-aierial over a period of ten hours weekly or more .or periods longer than one year should observe the =o.lowing rules: Pi e-ernp!o\merit and pci iodic x-i tv studies of the cnew, with the use of large-shed films (T4 bv 17 inches) should be made. A'hen possible the workers should be rotated. Approved respiratory devices, with additional Protection for the eyes, should be worn. _ Mechanical ventilation should be provided in the immediate vicinity of the work area. S ummary A 52-> ear-old man was first seen at the Grace -N ew Haven Hospital in January, 1954, because of acute arthritis of the right knee. Physical examination was negative except for the painful swelling of the knee. The blood pressure was 118/85. Hrittalysis was negative. The nonprotcin nitrogen was 38 mg,, the fasting blood sugar 100 mg., and the serum uric acid on 2 occasions 9 0 mg. and 9.9 mm per 100 ,] The acute att.-K k of gout responded m 21- bourn without '.pecifh thcrapv and lie was discharged on probenecid, 1 gin. twice a day, and a low-purine diet. Eighteen days later he ex perienced urticaria, which subsided when probenecd was discontinued. He was then advised to stop probenecid and to take colchicine, 1.2 mg. daily, as prophylaxis against funner acute attacks of gout. ' ' 111 March. 1954, probenecid, 1 gm. dailv, was restarted When next seen in M ay, 1954. the patient had gained 10 kg. f22 pou nd s), but no evidence of edem a was present. 4 W'O weeks later the w eight had increased further, and gross p it tln r r e d e m a w a s n o t e d . N o u r i n a l y s i s w a s done at that On the basis of a clinical and pathological study a case of pneumoconiosis in a worker engaged |n tne undercoating of automobiles with an asbestosjase compound, a cross-sectional survev of this operaaon m the Commonwealth of Massachusetts was unoertaken. Appropriate recommendations to protect IVom the D e p a r tm e n t o{ In te rn a l M ed ic ine, Yale U n it emits School of Mfcijcnc. Aided bv grants ftom the United States Public Health Service , H-834 l .nd the L a w ren c e Gelb F o undat io n t Vssistant resident in medicine, Y ale -N ew Haven Medical Center Med icin e "* C,' mC:,i P ,u f cssor of m ed ici ne, Yale Un iversity School of SAwistani piof.ssor of medicine Yale University School of Medicine established liiuMiitalor, American H eart Association. ` r In the form of Bencmid. Merck Sharp and D nhmc. West Point lYmnvKamn 380 THE NEW ENGLAND JOURNAL OF MEDICINE Aug. 24, 196! semblers and other state organizations responsible for the investigation of occupational health hazards. The case history was summarized and forwarded to these organizations with a request for information regarding whether similar cases had been observed in the past. None of these agencies had knowledge of any similar experiences. The information revealed that in plants outside of Massachusetts, an undercoating compound that contained a rubber or cork base was in use. In Massachusetts most of the automobile agencies are using an undercoating material that contains asbestos in an asphalt medium. _ The undercoating compounds used by the dealers included in this survey were manufactured by 5 dif ferent companies. The material consisted of an as bile raised by means of hydraulic lift. The operator sprayed the underside of the automobile. The actual spraying operation required approximately fifteen to thirty minutes. There was considerable back splash of the material, striking all parts of the operator, including the face. This contamination resulted in a reluctance of workers to undertake this work as a full-time occupation and led to frequent rotation of workers in this particular job. General means of ventilation such as a wall fan were provided at a few locations. It was noted that no special precaution"ere taken to prevent the inhalation of the disperse undercoating compound. Some of the operators wercprovided with plastic face shields or coated the!) faces with petroleum jelly. phalt base containing approximately 50 per cent of asbestos by weight. About 10 per cent of the constit uents were fillers such as clay. The material was of a mastic consistence, with a petroleum distillate such as a high-flash naphtha or kerosene as the solvent. Fifteen different types of American automobiles sold and serviced in Metropolitan Boston were se lected for a cross-sectional survey to study the under coating operation and its potential hazards. Fiftyfive automobile sales and service agencies were visited to obtain information on the number of cars under coated annually, the number of employees engaged in this operation, the methods of operation, the protec tive equipment worn by the operators and the com position of the undercoating compound being utilized. Industrial-hygiene units that had surveyed the ur dercoating operations in the past were interested pr:marily in the solvents used in the undercoating ma terial. Their analysis did not reveal any substanliai hazard attributable to these solvents. Our survey uaditected at determining whether asbestos constituted a hazard after the prolonged use of certain undejcoating compounds. Atmospheric samples were ob tained during the actual spraying of the undei- ` coating material. The average concentrations vadcc from 500,000 to 1,500,000 particles of asbestos pc cubic foot of air. Microscopical analysis showed tha j the asbestos was present in the form of dint pai f tides, less than 10 microns in length. The presen ! maximum allowable concentration for asbestos dust j The survey revealed that the number of cais un particles less than 10 microns long dispersed in iht dercoated by these establishments ranged from as working atmosphere, as set by the American Con low as 2 to as high as 600 per year. There was a re ference of Governmental Industrial Hygienists, id cent tendency to reduction in the amount of under 5,000,000 particles of asbestos per cubic foot of aii. coating as compared with previous years, since most The maximum allowable concentration for lono- fiber- of the new cars are delivered undercoated by the gieater than 10 microns in length has been tentaiiic- f assemblers. ly set in Massachusetts as 1,000,000 fibers per cubic 1 The undercoating operation was carried on as a foot of air. T he atmospheric contamination due to f rule by 1 or 2 employees at the close of the workday, asbestos in the operations surveyed, based on avail- I when the operator performed the undercoating opei- able standards, was not excessive. It was noted tiia' j ation on his own time, with extra compensation for in some cases the air samples picked up asbestos par- ? each car undercoated. The location of the operations tides surrounded by an asphalt coating. j varied at the different agencies. In most cases a sec Additional information about the health of cer- j tion of the garage area was set aside for the opera tain individual operators was obtained. At establish- tion, which might be performed in an open area or meats where at least 150 cars were undercoated an- segregated from the main repair operations by means nually it was recommended that an x-ray film of the j of canvas curtains used to prevent the material, chest (14 by 17 inches) be taken of each employe--1 ' during spraying, from lodging on other automobiles engaSc<^ *n tills operation. In some establishment:' in the area. About 25 per cent of the agencies had separate workrooms used exclusively for this opeiation. The undercoating material was usually re arrangements were made with the local health ur.k for free x-ray studies; in others, the expenses wet-' underwritten by the employer. Twenty-five of the ceived in 55-gallon drums and dumped into 275-gal employees involved had such films taken. All x-:ulon storage tanks. Under a pressure of approximately studies were interpreted as negative. 100 pounds per square inch the mastic material was forced through a spray gun of the type used in spray D iscussion painting. Parts of the automobile that were not un dercoated were protected during spraying by mask ing tape. The wheels were removed, and the automo I he observations here recorded raise the quest: ' whether the use of an undercoating material conta-t mg asbestos had a direct relation to the clinical ar-