Document 2JGOmLjLqmNK00VZQGKw74mja

FILE NAME Insurance Industry INS DATE 1939 DOC INS056 DOCUMENT DESCRIPTION Medical Journal Article - Current Comment Discussion of an X-Ray Study of the Lungs of Workmen in the Asbestos Industry Page 426 INDUSTRIAL MEDICINE October 193 is irritating to the skin The new insecticide reported here is a product known as alpha naphthyl isothiocyanate usually mixed with pyrethrum to obtain the toxic effect Current Comment EMERY R. HAYHURST M.D. Columbus Ohio N an Ray Study of the Lungs of Workmen I in the Asbestos Industry Covering a Period of Ten Years ARIAL W. GEORGE M.D. and RALPH D. LEONARD M.D describe an intensive study of workers exposed to the asbestos hazard in a large industrial plant in Massachusetts where brake linings were manufactured This study was begun in 1928. The asbestos contained somewhat less than 30 silica Dry weaving was first used later changed to wet weaving Of all cases examined in 1928 and 1929 12 were diagnosed as asbestosis by ray findings These were put on compensation or given a lump settlement They represented a very small number of the total employees Three cases were definitely advanced but without many of the usual clinical signs and would not change their occupation These remained with the plant until it was closed in 1936 and one of these became a litigant Within a short time after the closing of the plant 90 other workmen brought in claims for disability due to asbestosis These were examined and positive diagnoses of asbestosis made on 12 with three additional cases questionable About % of these 90 cases claimed symptoms The insurance carrier immediately arranged compensation or settlement in excess of 50,000 for these 12. Of the remaining 78 30 came to trial The Legal Aid Society furnished able counsel and the late John B. Hawes Jr. M.D. became the medical expert for them and made a positive diagnosis in the 30 cases The referee committee of three called Panel Doc- tors one a roentgenologist whose diagnosis is final examined 10 of these 30 cases without finding definitely stated asbestosis but their findings were reported as consistent with or a slight degree of or the probability of asbestosis They were obviously depending upon the history of exposure and not on the ray findings alone This feature of exposure appeared also to influence Dr. Hawes in some 80 of his positive diagnoses He based his diagnosis and prognosis upon 1 History of exposure 2 difficulty in breathing on exertion 3 cough 4 rapidity of heart action on exertion and 5 that asbestosis was a progressive disease once contracted whether the individ- ual remained in the industry or was removed The authors find also that a large number of asbestosis cases gave the history of coughing up blood Irritation on the hands may develop into open ulcers whose bases show asbestos fibers imbedded in the deep layers of the skin Probably a similar condition may develop in the air passages Certain individuals seem sensitive and others im- mune for which no satisfactory explanation is at In Radiology Vol 33 196-202 August 1939 breathing hand unless possibly the method of examination of the 12 original cases made at the time of one of the hearings showed them to be free of all symptoms and except for several women in their group they were doing laborious work in new occupations This was eight or nine years after their original cessation of exposure It is evident that if a history of exposure is eliminated a positive clinical diagnosis of asbestosis cannot be made and reliance must be placed upon the ray examination Further it appears that asbestos dust will not give symptoms until there are visible changes in the ray film The more characteristic findings are described in detail briefly summarized as Bilateral dis- tribution limited to the lower lobes of both lungs at first as a ground glass or smoky appearance absence of gross nodulation - what nodulation there is has a fine evenly distributed quality no characteristic hilum or root shadow changes al- though there is often some accentuation of the bronchial shadows which present a laminated appearance in the lower lobes probably localized emphysema with atelectasis accentuation of interlobar pleural septa lower chest pleuritic adhesions with obliteration of the costophrenic angles emphysema and more dilatation of the right heart than seen in other pneumoconioses but no demonstrable dilatation of the pulmonary artery No cases of complicating tuberculosis were found nor was there evidence of asbestosis lighting up a pre- exixsting tuberculosis Differential diagnosis would include other pneu moconiosis especially silicosis tuberculosis lower lobe congestion from various causes accentuation of the bronchial shadows in the lower lobes and chronic bronchitis or bronchiectasis but neither of these latter conditions usually show an associ- ated ground glass appearance The authors conclude that each asbestos in- dustry and exposure must be an especial study in itself the percentage of silica must be taken into consideration and whether the methods used were dry or wet asbestosis is not a progressive disease after the individual is removed from the dust exposure there is no evidence of any causal rela- tion to tuberculosis final diagnosis must depend mainly on ray evidence there being no pathog- nomonic clinical findings and that an amount of asbestosis dust in the lungs sufficient to produce symptoms will give visible evidence on the ray film Toxic Fumes -in Massachusetts Industries- HERVEY B. ELKINS Chemist Massachusetts Division of Occupational Hygiene Boston OST occupational diseases into one of three groups 1. Dust diseases 2. Occupational dermatoses fall roughly a 8 No. 10 INDUSTRI 3. Poisoning by toxic fumes and gases received Of these three categories the first have received The most attention the second are the most numer bus and the third are the most varied and form the subject of this discussion primarily primarily i While the dust diseases affect the fungs and derinatoses are by definition skin dis LEFT Dope room of an artificial leather factory sources of benzol vapor RIGIIT Same after insta ment Even with tubs of dope and mixers covered of solvent vapor escape Ventilation is th eases toxic gases and fumes may act selectively ,, any part of the body For example the lining the nose the very doorway to the system is Hf tacked by chromic acid while the bladder almo ^'the last organ which contacts waste matter befol it is eliminated is the site of tumors caused b some amino compounds used chiefly in makin is dyes Many other toxic fy fumes attack the lower 7 respiratory tract liver kidneys forming mechanism and nervous -system In variety of ac- < tion on the body the gases and fumes are cer- * tainly the most interest- ing of the occupational * hazards c= It has been shown in- numerable times that most industrial poisonings occur through the | respiratory tract i.e. they are caused by breathing in the toxic - agent which may be in the form of a gas LEFT Table for fur volved exposure to table Without pro RIGHT Acid pickli fume dust or this The industrial hygienist recognizes this as ax _ matic but others do not always do so c. We recently learned of several cases of lead p : soning among painters engaged in coating stri * tural steel with red lead paint Three theories of how these cases occurred w F. advanced The paint was partly sprayed and pa = ly brushed Water was supplied the painters in F: open pail and it was found that this was freque y ly well flavored with red lead paint from the spr