Document 44exRdyNo1EeZDevjrpQO501p

File Name Lanza Correspondence Scanned ? Source JMA: Start Year 1929 Stop Year 1952 Contents letter, report Notes -s. -,* 1 . 1 *' tholr r through tb Mok, thus toadlag to dg*on*trt th# iaiffocUTonot* of Rukt. loftronoo olio vao a*4# to Uui.#, . rtport of tht lo* lortc itoto D#p*rtMat of Libor Juno 16. 1081. a oopr of ohloh vo lotto* la ohich thf Mat it Md that Mki aro aot affocti?# la MtMmSte-jS oorkaoa fro* tha porila of hroathtag r5j*k doit. f .<Vrv. - ' `A-V ' ,>! sr * ''vmsmz-x Jlletnrpaiifto' jUiv, ` jW<9L<&* v . ' ,, f. . lo'TMbif 8J, UM Sr. Alim lutfeoll, if tread ftraat, tor fork Oity. I tear Ifr* terdvmUi i X taoloae tfa bibliography cm eteeatoala* Thera.y>v ara tim article* la tfcla llat that appeared l^Tubarole", aa >'i ,> . fefUah pahUoatloafiad I aa aeadlAf far aatra ooftea of thaaa* : V. aad toe X cat that X ahall wad a aat to Sr. tyatt la leaarfc* ' her# alaott aaepleted ear aark la StanUa took ,. aa feead a larger Job thaa aa had aatlelpatad* X apant a day than! re- eaetlr aad faoad It a aaiy flat plwt ladeed. - i- Plaaaa lot aa fcabt If aa oaa aaoara aay other la* tfon*\loa for you. VLth boat rogarde, 1 aa* , MSTUOPULTrA* LIFE iRSUfUICE COMPACT Frederick H, Bcker, President enr Tort City. Anthony j* Lama, M.D. Assistant Medical Director* ` ,<'* . '"* x# . ( :<V Vandiver Brown, Kao., Johas-4UnTille, 92 Madison Avenue, lav Toxic, I.T. ' . Saar It*. Brcvu; Manj thanks Indeed for your latter of Hay 2hth and the two roluaej of the record of the cue of Butler. I am vary glad indeed to get tile material and appreciate your oourtesy in sand- ing it to me. . 4 V\ r/ ' I ta now back is lew lork for good and hop# to drop la and see you some tlae in the near future. is you ere probably aware, there are a great many of < these suite being filed, particularly in Bochester. X have had several attorneys end other interest people cone to me for sueh adrice as 1 could give thee. These people always ak if X can refer than to others ^ho have had similar experiences. I have always *. refrained free mentioning the lohns-Hanrlile Company or anybody connected with it in ftnjr way but 1 aa wondering whether there might not be eoao edventage in a community of interests, so to speak, for after ell misery loves oompany. Mr. folger of Barrls, Beach, Folger, Bacon and Keating, 40 Franklin Street, Eocheater, lew fork, Attorney for the lew fork Central Railroad, Is handling a great many of these cases. A Mr. Bardigg of the American Society of Mechanical Soglneers `is trying to get up so-- sort of a Manufacturers1 Defense Association on behalf of the abrasive industries, end a Mr. de Biola, who used to be the heed of the safety department of the Dupont organisa tion le also trying to get together some organisation for the benefit of the Bochester **suf*ctorero. : ; ,v,,i /% \ . , hall appreciate It if you will let me know some timo nfer . with any or all of or attitude that X hate lit the past`d of' frrffHttier.t anthoritlH in fashini Mx filacersly. . wum Imtmrr Ml II tot* Daofild S. Qmdaf* Stf 1* QoOfOt&O fitfOOt Ircaoood* Blthifta r?&- : *'. * * ' ' X Jut roolYod yoar Xottor of lawny & nhloh l torfa' toy Tory orfiUyi X m 1a thoroofh iirwwl Ub that yoo toy do not think thoro In any foaotloa at all bat that *11 of a, at thoao of mo in tu tooloido CXnbv aro in tborooffc aocprl la till X HI Ml talk with My of tho dolfotoo proinnt at M Htoa*. barfb aftInf oaf X did aot f*t ay lymloi Mr<rtw iMr tt,' to tholr aaia lntorost b*U* ia fifhtla* alala*. X proma. that tt4 . U bo Pa for mm of tbaa aad poorifely for tho aaiarlty if ttoiihtol do rsot think troo what X tear of *o tollra Uwtttot* that yoa totodfiat thi Valloa Zaatltato to oot ap aa oryaarlaatloa dhlaflf latoroatod la lata flfbtLac* . :: Ar. loUor ootUaod hlo porltlca to Kr aloe to lnteyrtN aad toy froafcly* X aa to orory tUtoooat that yoa lodo ia your latter to no both ftm 4t bo aid bad froo w' kawdedfa of hi*. fie* it ii peealhto that fir any toko a dlffereat He* bat X Mt It* . J*. : X oao not laoltaod to pay too aaah attoatlea to ooao of ta ro* ooUoaaiy lUtwata that aoro aado by oao or too of the op--tor* aa thy two ipwUl pludaro nad iaaro roaofalood aa awh lr too fiOttMM. |t mr ba that the offrat* efthelr tatoaaato tora oat of proyortii at for aa tho anitanno too ooaotaaod* If oo# t thiafc that ia too tot. PoeolUy Dr* boiOota aad Mr. Kltoaa* 4U oot aako NffUUnOy oloar tot tor had la aiad tt aottlag ay a Mini oo rrdtaatlfig agaioy* X flad ifdlfflealt to bollara that toy weald to oo rtnrtrlfhted ad to hara aayBiton^:^!^^^*^ art errulM oa tho feroadart aad toft aoafnX Mlontlfta Uaa aLll aoea aaaato tto *eetiM~ ,s"- \Xr!r -A - ' ' X Toald tpprtoiata it tor* if, aftwr tha OhltofT aoaf that ydto lapnrmorrllfelaa*i twt aad toithnr thahko hr yoor latter, X aa ttaemly, . -ik":- I'lciKuruLiiAfN Lift INbURANCE COMPANY FrEOIDICK H.ECKCR. PtJiOlNt NiwYopk CttY ANTHONY J LANTA.M 0 February 26f 1935 , . .v -t -' >. :.srcy .3. Sirtnao ^aborit.ory, Safirvc U*:e, 5. I. ^-eotv*, lei I ~ave ycur letter cf Secruary 24 tad cannot say that I Wane y:u fcr feeling tozt+r.zz yizzl*i a:sut the orosent situation* Bosevtgr* a It-, of tie -cpafasidn due to sissader*tending and a general greplftf around. I this!-: 1: Till straight as itself out. I enclose a cojy ot a letter that I *rn to let. At the recies* of !ir, fcitchins, I also tent a :sr to I'r. Ger.tbolti of tie rer-bli: Steel Ccsrtfcy *ad I have sent a oor/ to fr. 3*>-ers ant *hr. Fletsr.er cf tie St. Joseph Lead Ceapany, who has been quite a help. .- Tbit .coming, I hive a vetre free fen faring that he has delayed re riming t: 1 rw?s:i as he is to tp;ar before the legislative Cocslttee ir. Chic 'conbliarlng the siliscsis bill. He intlwatei that Hitchins and his group rill gat the support of the iron and steel people If they can straight en cut soso of their risunderstaniL&gs. I tried to clarify tile situation in ey letter asd only hope that I did not succeed in siddllng it the ocre. '. ' . . t \\ * ; I. have no idea at this tine whether qr iwtthc 'scheme ppojcstd in Pittsburgh is going, to -w^ris and whether, If it ecrlfSi any of us will want to have any thing to do with If they riot to center. their efforts on the litlgative and legal aspects of the question, then neither you nor I nor the fobllc;Health Service sill be interested. If they rich to sponsor and co ordinate research, then they cannot get along without the support of the Public Health Service and Saranac. In any event, I do net ace that Saranac . is in ahy *57 threatened*'*' Bobody is going to set up a research or Investiga tive or^taisttfon to do what you and the Public Health Service are now doing. I do not:.set ahy ohanco cf ry being able to give anything rore to the cenvy aoad their representatives- to decide what and ho*'they rtah it done. nnno  FObrtury SB, l. Dr Astbony Xransa Metropolitan idfo Xnatzranct Cospanr jaw York City V> 'C Daar Tcnyt Tour lottort havt dona t lot to straight** af on thinking oo tb* sattor of tbo Stllsosis Truitt X *b glad ts too* short job stand ton--as it Bill >r bolp b* In wy rolatlono with tb* stbsr foopl* sob* qonod* X n sorry job fool tbit torn fiat tabs tbs* psrocBol stand that job ha-- vttk vt|B| t it# botl X ots approolat* that `yoa weald haMLyaaro t* tskmh asj othar# at Xaast for tbs iwnrtt Your lattar ta OmIbci ateniSA bs wnt ^ gratifying to Mi Tor apparontly job told Mr* Hltohlna oat of tba things that Dob fait ho afcoald boar# X '- s glad that tbtj Istond to go siaj Ott tbs sapsadi^M tort of thoir first |85y000# Xf thsy --Sold asks mistaka* vith It thoy sight --r bs obis ts git Boas* I understand *oat of tbs asabsr* haroalroadjdoctrl* tratsd tbsir first lnitalawfc of #6MsaSh and } bop# aoBSbody holds it tight until tboro Is gsaoral agrsio wont ob obsrs it idiOBld bs jplsssdt . . t do not oacpeot ts bs in tba city in tbs nary Dtar fntnrs bat if X do bars oosasloB to sobs dopro job Bay bs stars X will drop la* . - SlaosroXy years* Lrector, I Ce =r He**: H*r***tth . `-.tr.iii plan fer a Dust Institute. As far as I v ,i is C.'<. 'ey the s-ail group whose 1.'* t'.'5 *: a:,; *:..!*: vrrv.o. 7>.*s I get the final Check fr*- each or.*, I ~.l '.r*.rarit the piaa to Hr. Hitebins is*: 2r. Shervoed :.? *,:*-n can .tahe it or leave It. If they ) ta..c' it and agree imp all reference to the subject of elfins, I thin.*: v.e ihrst Institute trill go ahead* If they Ln.'slst on ir.jescir* -lairs and dels natters as an essential part of the Lust Inctivute, then all the rest of ua will pr-r^tiy Jrop out, in *,-;ich case, I thiah that Don1# contacts vlU *robbly s*t ur rnx independent venture of their on. I have oot forgotten the rsatter of Ateell and will get hold of '*x. Fletcher In a lay or tw>$ %! Best regcrls* \' Sincerely yours, 3,./ tr k, J. Lania Assistant 'iedlcal Director ANTHONY J l \S7iiiVr+MeivI-i .. J ft. IIUVI'AHVOV^ PKtDFFlCK K ICKE*. Cksinw / lb M Llroy A.Ukcoi.n. h**40*i NFV* VOKK cm VandiTer 9ro..nt Esq.f General Attorney, John* lfcnvil.1* Corporation 22 East 40th Street, Hew lork, M.Y. Decjr Hr. Brown: With further reference to your question concerning Richaond, I reeetabered after I returned to m/ office that I bad had a conversation with a Dr. Edward Arthur Del&rue, e young doctor in Richaond who seans to be vary well connected and who is anxious to get Into industrial work. He is thirty-three years old, war graduated in Richmond in 1933, *-od has an office at 116 Raft franklin Street, Richmond. He struck h is & per sonable young nan with a good background night be worth considering. Sincerely youre, iA/<7/*o ! kr. F. G. blppert,GH 1, Lanza, #.D. Aksistont Medical director / . ' "V / / y . / /' // , V (7/) :('U . 7 /sy / y< s / * * Occupational Health Bulletin nRH DlVvTOrivCBOUS EARTH PNS?r.-;OrjChlCEIS Diatomaccous earth is a fora of "free silica/' or silicon dioxide Like the ordinary silica from quarts, diatonaceous earth, when inhaled in sufficient ancer.ts over sufficient periods of tine, enus-.-s a disabling and often fatal disease of the lungs. . In this country the disease 5 s usually tarred ndiatomuceous earth pneumo coniosis.1'"* In Europe it is ordinarily referred to as silicosis due to di-ator.aceous earth. The disease differs in certain characteristics trots, and has certain basic similarities to, conventional silicosis. These v.ill be discussed. . Vhat Is Diateraceous Earth? . The natural or ray diatoraceous earth is a fine grained material composed of the siliceous skeletons of tiny aquatic plants known as diutev.s. through the aces, these have been deposited on the bottoms of bodies of fresh and salt water, In various parts cf the world, these deposits hxvo appeared at the earth1 s sur- face and r.-my of then arc no;: being commercially exploited. Hir.oralogicnlly, diator.aceeus earth is classified as opal , a hydrous form of silica. The pure mineral is entire]/ free silica (silicon dioxide - S.IO2), but ir. ' ts natural slate dintc.-aceous earth contains about A5 to /,0;' vatcr. _ termerrnisi varieties variously contain s.v.nll amounts cf irpuri tic;; sur.ii as clay * lilac, quarts, end others. rracticaJ.lv nil samples of the dry earth, however, contain unward:; of 75; silicon dioxide. The natural diatomceous 11 let differs fro-, quart: silien, tho cn.i:.-..vn tyyi? four/: ji\ : ns l Junes, in the f. I V.nl qirrrt:: r.U.ien. shews a characteristic cry;.*.*.] I ] r.a jmttern in xtn.i.u* with I ri; ,-.!.,.y sy.-; l^oneLer, '.V'-na': tire r*.w `E-'roo silica" is silicon dioxide (hiO,). ?.r. | -,m '7-i:iio:h:; i *. n [yn'r l l.rrr: f.*e dij.r-s:* <:* iiv* 1 u:i..r: ro;.u'1tlp;; tee 7. ,\ \ r <. 1 r* * r : ;.........1 . 1 . * >; - :..... r.. (, . .. *,..> ;r. falif/rr.ic, tlv.* Jehu..-'kavi ilv /--.ere ia V* te the larrasi prceucvr r:` the material th:- '.oria, c.'r"inly ir. :.vi IV.-Ved l-cl-o. lir,;c pre-Juscr in California is thv Crv.t lakes Car:T. Cnrr/jratia:*., which ;:r l. t r-sr `..'alld-in, Las A;q;ke:; Count./, uni ic ra- ccscaructiag ;t large plant r.cur Lompoc. There ire othir era 11 producers in San;u. farnarc, Inyo and /on lloro Counties. 4 In recognition of the potential danger to workers handling diitcmacocuc earth productc, the leading producers huv-o recently inaugurated a program of labelling the containers of the powdered products as follows: Caution ' . . uCcliteM materials consist cf an almost pure amorphous ciiatcmaccous silica plus varying percentages of crystalline silica. Inhalation of silica dust over long periods nay be harmful. The materials should be used so as not to create dust or--if this is not possible--employees should be equipped with adequate protective devices. (2) . . .. .. ' ` . In the producing industries, there are numerous dust generating operations yhich have been incriminated as sources cf disease. However, in California at leant, the chief danger scots today are in the occupations having to do with sacking the materials, loading then into railroad cars, and in the baghouses.* In the diatccacaous-earth-usir.g industries, some of the trouble spots are those in which the materials are unloaded iron railroad cars or other vehicles, or in which the material is emptied from sacks ar.i rclucd with other rate rials or other- vise used. ' .. Humber of Workers fVoocei '. In the mining and milling industries of the four western-states, there are about 1,CC0 employees (about 00 in California) employed at ar.y one time. Kowevor, the labor turn-over in the dusty jobs is exceedingly high, ranging up to almost 490;> per year in certain instancesj so that the number of workers exposed, whose lungs nzy have been damaged, is impossible to ascertain. The number of workers exposed to the dust in the numerous industries using these products is not lino'.n, but is probably very high. Tt!E blfiACC History In Til urn.', rating r. Hot '^ad Oftun hn rh In California, di. tomsccunr. earth has been r.irr.d r.nd processed for almost* */.) y-miv.. ro.nyvsorki (j) ; n C.'-~z:\y rep :rtvd i :i 1-HO oy.pLrlr.v.hii in whic'n he van ah'./- in pro iuce in animals true gr-.mvlo.;uitou^ ,:c..t:tc by roducln;; ihe dust surcuta:vvous 1 y. .mu./. 11 i:; a )n:v,i: ten'; for bar ha t <hi ;L f.i i turn, Mipyu l mu:; m;; c.fl) eclo" u:.l`, including fabric Urn lay/., :j r.hakiv; syy-ivi, a;vi 'diaU--'-aJ earth : s v.r.y.lly ''ruergke-: i.o., it '..il J to show n. defini to crystalline pattern with p:v.-*;L\y .v/ali-blo xl. VJhcn the natural dlalovnc -a \z earth is subjected to heating (colciri a;;) ;m:l trect-.-'r.t (fluxing) with certain cr.-rzicals (suck as saliva c.artorcto) in _kc ra"nuf-cLure of r.uzcroas coranvrcizl products, a varying proportion c: the so-called Oworphous foiTc is converted to a crystallize lorn of silica known as crisisball to. In the* United States, dia tokaceous earth ar.d its preduo to are known by a lzrge variety of r.r.vas, cozncrcial and otherwise: diatcrile, oolite, dicalitc, etc., end there are various designations for powders ccr.t:.ir_Lng fixtures of diatonaccous earth and other dusts, ouch as siloed, etc. In Furope, there arc also jaany designations for the sar.e materials: 'infusorial, earth, kicsolguhr, fossil flour, fossil real, trizoiiie, polirschiefcr, desuid earth, r.elcra, white peat, tellurirye, rar.dar.itc, fcergrehl, etc. Uses of Piatcracnous farth ' . Diutomceous earth in one or another fora finds numerous practical applica tions: A few onc.plos arc: . a. Filtering and rcflnirr of sugar, syrups, spirits, juices, voters, petroleur products, ch.erJ.cals, varnishes, senzas, pharizzcouticais, etc. b. Insulation of heat and cold in: power plant equipment,steel`plants, . pctrolcun refineries, glass nanufacturing, furnaces, l-tilns, refrigerators, etc. . . .* c* fillers: in battery boxes, roofing, flooring, vexes, paints, plenties, explosives, insecticides, abrasives, cosr.etics, fertilisers, etc. d. Puilding industry: acldxturc for concrete, cements, plasters, hi-silica and puzsoian ccaents, roads, light weight building blocks, etc. c. Flsccllnncnws: Manufacture of filter candles, soluble silicates, glazes, oil-clccolorizing products, poultry litter, sweeping granules, etc. uses of dieted to in the United Filtration Insulation Killers, r.i s c 011 ate01u" 50.% 25% 25% In 1947, production in the United Slates reached 213,5Ud short tons and today the figure is doubtless t.-.ueh larger. (1) . _ pecutdicrsl >rd Tr. Irstri d vwnuvs I'oUr.Ual occupational :jai;.m**-'.:; in the niry.*ro;is ir/Urjtries which utilie.e ike ;:uLerial. ifov.A'-.r, tkv ivsl. ir.porl vit :K.-,r'V\: of disease has toon ir. t*r? j vdusi rif-r. vivy.g-d j n y'wuv.i :gg t'*:? vUrrinl m: i its pvainoir. Uhilc* d-'t-w.. t;; 1.:' v 'irth vy he ! :i\uv'i in ir-.ny .-art:; lh f.l ; tv:;, pe-rS.stly U - * iy ( >.;:Vd J--.I lyv i t:: a / ` .in th.e i.v.t; (*. .1 iftrnin, Piv.yin, . 1 . - : > : - , ?.......... ; r! t T ;v.v!tv ` i ,*., i .;...w rile r. rf rcrcu: l a 1 i: .: :c 1.be h ..1 ic v. .: r s i * , in th's con ubry began* vili: on o publis'v.l by .!. i :; son K:v':n.. a of Cr.-r;y, J-: -soy, in 1-369. ;io describ:;d zeme LC1 Lnti a rn of Or;.r.-_- vh.o '..'Ji'c vi cLius of typ mercurial poison-t.>i j bu a ;-'a rr pass- before id: j n a y. ^ : cc-- ord <:pp eared, quit.e as r! lochi T;I; ll w cTi e fi rs t. go thing vas dona about it. lit tic alient:.on ves i U ; r.a no iyj the medical ucr-ld. Tuan in 1912, 37 years later, the public ;.-.e start Inc by a report made by a lay organization, the rational Civic feierntien........." If the reader will substitute the I.egge and rjrer.crcntc study for the rl'cenan study in I960 and the California Tuberculosi u.-.d health Association fer the Notional Civic federation, a similar picture heccr-jc acoarert. Donning (17) summarizes the problem veil: "It is apparent in the study, control, ar.d prevention of occupational health hazards......... that the united Scutes is act or. a par ;rith other countries. Lac*: of recognition of the iupcrtar.ee of industrial chin cancel* stands out in sharp contrast to the unrestricted ar.d 'wi.de publicity given this important matter in Lr. gland, Germany, ar.d Svitner- lcnd, vhers these cancers are notifiable ar.d compensable diseases, ar.ci information regarding them, therefor.-:, is relatively' reliable. The history of industrial r.cdicir.e here is full cf failures to prevent the unnecessary deaths in industry that have occurred, for example, from berylliosis of the shin and iur.g, career of the lung from chromates, tumors of the bladder due to aniline dyes, osteogenic tumors from radioactive chemicals, and cancer due to carcinogens .in the tar indus try. All these industrial hazards could have been controlled or clininated." Incidence and Prevalence o. c C> so. 'r o ho accurate data arc available because of (1) ignorance on the part cf most physicians of the existence of the disease} (2) tie:; resemblance of (ha disease to pulmonary tuberculosis; (3) the failure to report the disease according to require jeents of the California Into:* Code.*- (Id) Despite this situation, some figures at hand arc revealing. In the 1930 stu-Jy of I.eggn, of 1C3 urn essoined, cl cr 63.y' had abr.oir.ai lung changes, Twenty years later, the )>or.poc plant ehyzi cir.n rut ratted to the press his report that of 922 people ho examined since .IfL5, 33O'.i had lung changes. (If.) w The j'v.rcau'r; nnrtnl source of inform-, or. ocrvrntlonnl disease is the reporting required by law to the fall f-v.T.ia Lieto Deportment of Industrial Ho- 11 lues. Lection 6407 of the tabor Code stales: "ivory employer, insurer. end j L/ri rieii or :;u*q wi iv,;> att-er.L; ;; injure.I empug.v a rh.ul.l idle \ri: L the Dlvir.io:: of Labor Jibuti;,tics ar.d earch, usier j;:Ioo and rcgu'uaicn:; pv- sc. rib.:d by the Givi: icn of Labor L si i d -a.:, rub, a coma] uln Ji:,::>rt of every irjwiy (o eoHi r.r.-Vjy ar l.-. In. g <*. of in [hr. course of hi:: r:i,i] oyv r.t uni'::..; d i :.-iM ! 1 iy i\ a*. t f \..n :e:~h injury dees not .last IhiMi* ); ti.*i tf.y nr d**.`S n. L re. ui.w r leal otVr Vru\ ordinary f irst 'I I. n IV a ie 1 ; oi `1 V .uvu ::i.\ l.o l .* 1 : i *J , , i a.'auj . . ; 1 . ` . 9. four u C:v id. .nc of U 1 w r \*' S'.Jw rirlh a. ; . ) si. > ' ` 1 . * ' a U ' 9auH l:i nltk 1 1 j j vf A 7 ; - liev'y c. s - it u. 1 c: ... s. a : a fs (>1 the i\ :h.u v Acs id an t Car.a 1 s; tor. sf..l oik- u SO-.1 sc* 9 ;n tla.ua,- iu S' /, tiou. is reve .3 ar.__ r.or ci iSai. (Tr arc ere a nwV. . r of css-'- ; \*iit > U. ' 'Cj. a j l *_ a' iu ..us V - k Ace i1 i JU l Conrj.es icn file tp : 0 !a te (jf ;:re;:r.:vcie of ale c;l11. Ctr. 0 r.er hj Ivu 2) t fie Da v.Lsi cn cf Li. tin C-tati st..CS s r:l fescssah i uus.-ivod fo: x a1' .u ic.; ar.s ror orts oi t he disease, all cf th uiv a January 195 t: trough clue i. cf e.ll cr.y loyc re i epoi 1t rJ- r..0n..--4 1943 to z .he end of 1951 by th C Div-.sisn rove als one re- por t, wn.ich was received in Dgeem be i' 1951. rb the relatively ssaill mailer oC workers c-uroced at cry cr.s lino, the attack ate is high by any standard, over. or. the tecta cf very ir.ccnplcte data Tuberculosis statistics for Santa Barbara County for the area where ths diatcuacoous. cart!; industry is located are now being critically analysed. P.cports in the lay press indicate they were lagh. (15) Pathology of the Dicoc.cc ' * Viglinni (S) describes the lungs of two workers who died after 11 years of expo sure to the calcined cliatoaaccouc earth dust:. . "The lung changes......... in the final stage becaa-e a diffuse fibre tic and hyaline sclerosis fairly similar to ir.af of the uassive euarts silicosis. But ro have noted cone important differences Iron the usual guartc silicosis; lack of hyr.liniced single or ccnglcrerutcd nodules and different features of the charges leading to sclerosis. These changes consist in a diffuse cellular thickening of the walls of the lung air spaces, produced by proliferation of duct phagocytes. This proliferation becomes gradually so narkei that it replaces evury air space and initiates a missive granulosis, which only iu a very late- stage becor.es fibrotic. faphysevra, dilation of blood capillaries, and hyperplasia of all the sr.ooth muscle cells of the arterioles end bronchi are secondary phenomena. * . "The diffuse distribution of changes in the air spaces somewhat resembles that of ashestesis.........,r . Vorwald (13) describes the lunge of 10 workers (0 r.fte surgery), vho had exposures "ranging iron two to 03 yours." pathology as follows; death and 2 after he SiUauiriacs the "Although there are scattered feci of hyaliiuvatlon end nervesis not unlike the pulmonary response to inhaled ouertr., nevertheless the fibrosis is generally no re diffuse and cellular in tyo ar.d involves nut only Ike perivascular and peribronchial tissue but, end non; especially, the alveolar walls. These ere greatly thicker.;! end often fused; the olvruOcr spares .-re cUk-r ob) i tented, greatly L'islurtril end sv.ull, yr ;-.ve vv,la.r;.ci ;o for:*. er.ghyncr.al er.u arcs:;. Vi .* diffuse cellular pu!"on.iry filavsiu s rev.- t. tv. the r.eat i:vrort;u:t. le..ian. It r.v.e serious tlu.n dincr.Hv iwk; tar f.\b:vsis of Uj.cur.pl lea ted ailicosi.i i'.rl is, p'rj'ip:;, i\ rron.:- Hie for the pro- nwic-d respiratory difficulty ene.au:lured in of this disease. M ;'Us (i.*i 'ire-? feu.,..;; vts, i'< to-. t-: :\r.l cvi :U`/.*) vvro four:: ip. p-,, hi::;;: sf^'V:u 111casv:; by vaarvj of H :. -my diff; -,'j', iop tv:4,i'n i*i*:. Hu..i:\v:r , l1:*; rmye c-f r.m nulls four/; lae/;` In.-,;., is; bred :. r/.l r.o cm l-: ;.el Jn `.i l o'* Varm, la1 a evens except era, the rrmr ta iil ice cur.tvr.t did rot exceed frcn irrr'. ho concludes l-va "quarts is not the primary toxic eqmit......... cither cristobulitn or dic.tovJ.tc reus l bn Incriminat: ti Since deposits of dir. cord to contain varying ncounts of c.uarta, the precise type of lesion produced any vary* with the quarts contest of the duct. Thus Hordmann's (6) cases showed typical quarts silicosis lesienG in addition to evidence of c.iatoaacsous earth. These people had t:-cn exposed to diatomaccsus earth containiu~ significant ov.our.ls of quart-. Patholo.ncal Hrd-Fosul ts Regardless of the nir.utiae of patholoyy, this disease, li.he ordinary quarts silicosis, nets up the usual vicious circle of effects; fibrosis, cnpayse:aa, right heart embarrassment with the consequent cynptozs of respiratory end circula- toiy failure. . Susceptibility to Tuberculosis end Other Resoiratcim Diseases There 13 suggestive evidence to indicate-that diatoasceous earth pneumaaonios.ls predisposes to pulronary tuberculosis. (";) However, there has been no adequate study of this question. Tnere is, of course, no evidence for the oft-repee.tcd uyth that dintonaccous earth confers resistance to tuberculosis. On the contrary, those vith the combined diseases have practically a hopeless prognosis. . YorvrJLd (13) states, "Our experimental results indicate the deleterious effect of the fused calcined product on the course of associated tuberculosis infection. Several of the patients studied had extensive tuDarculosis Doctors for the industry state that there seems also to he an increased incidence to pneumonia and acuto pneumonitis among tn.cse vho develop the corglom- era.to lesiens of diatomaceouc earth pn-aisaoconiosis. (25) . ' Role of Different Forms of Diatomcceous Harth . There arc two primary types of cii-ntcar-ceouG earth.; (a) the crude or so-called amorphous for - .--,n (b) the processed form ,.-hich has been heated to high tempera tures and treated vith a flu::, usually r.c.liur carbonate. There is agreement by ell iuvesti^a.tors that the fluxed end calcined variety, which contains largo of HiO- crislobnlitc, is highly to:d.c, more so than quarts silica. The role of amorphous diatonito has not tarn studied r.r. veil. However, thorn is good evidence that it is capable of causing disease if there is sufficient expo sure to it. (13,19) . All forms of the dust cause lung changes within a year or more of exposure.fo".o i nr. tn iu:vr. c>f r.art.cd lung chru.-'.'X: have -Irvebpi e.r. c*. rly an six months niter (v* i\`ui. (Hu) In g. nr ml it is 1 r i.i.r.vd that il.e* ;.;.;srj:)uv.:s lor.r car: uroeuao din*; r,u but vill taV:u lou;*,v*r to do i t-. Jn oxp Tim.Vit.; by (V); l-.? r -t dv. ^r (nuorphcu::; diatom- cvv-1.; c iilr) as h;.u\;; \n t*>m--Wy t > ru..' ts lie":; i'..........aP.itPj at* .-.or'';'-!:.- :*i ! .* cn.........w; t/c" .. r.vyc' .*i v. - f 1 b:"v; i s jrviis' Lrg'V.snablo J ro:.: the :*. :'ro , qu_!rt2." r. : fo;-.'. 1 c:-i su-iv.! lU- Lo b.* : Iv-.ie uxu wi'.hui* or ciLaV-milv. Vorv-nld sx.-narir.ec t!:-: subject ns follow.;; "CLinLc:.! end cvecri:.vitr.l cvid'.nee ir.licntc that h'>L;i crt.ie end flu/r'.i, ca1c::vi d: alrracecus earth rro czprbl-:- o'* .iroduri!^ ivl::o;::ry fibrosis, tb-j .Ir.LLcr ;:.ore than the fer;;.;r.,: (13):.* Si-ns rr.d S^p tores 4 In general, the symntcr.s of this disease arc* siuilar to those of silicosis r.nd other pacur.Gconiosos as well e.s pulmonary tuberculosis. The enset is general! insidious with dyr.r.r.oa, courh, chest rain. loss of weirht .or.d Ions of euo?titc. Spontaneous pneumothorax is much rurc frcru^nl in this cliesosss thr.n it is in classier! silicosis, as a result of the formation of emphysematous bullae at the pleural surface. * .` . . As tho disease progresses, the individual boccr.os increasingly disabled. Death has ensue! in known cases within a few months to several years from the onset of symptoms. ... -. . . .' The immediate cruse of death ray be heart- failure, spontaneous pneumothorax, superimposed tuberculosis, or other infections, or other pneumonic or cardie-, vascular .complications predisposed by the basic lung disease. . The course of the disease is generally more rapid than that of classical silicosis. Vorkers who stop closure to the dust after only minimal lung changes have taken place r.ay retard the progress of the disease. On the other hand, the disease my progress after cessation of exposure at any stage. ` Superinposition of tuberculosis, of course, worsens the prognosis. X-Ray Findings The earliest lung changes seen arc descried as "linear exaggeration." Another change often seen is that of fine reticulation, producing a sort of ground glass appearance. follcvirg this stage there r.ay be seen evidence of nodule.lion, but the nodules in this disease arc net as discrete as those of clas sical silicosis. In acre severe cases no nodulrtiou may be detected as the disease advances with conglomerate, spreading, coxiesceni lesions. * Poitcvin (!/.), of Canada, reports or. interesting exp..ricr.ee with dialsiorceoy.i; earth in critic: "These r.si.ur.ls vw suffering fro:j infected bladder rad the disease v:is known locally as fed L'ntvr. This disease was noted uspcciallv in Hritisli Columbia in pasture areas flscbiu every spring r.r/i where cattle were place! after the valor hod recoded. The coil and tire gras: wore .studied ar.-i thvy v-.*re found to contain a largo pv*c.:r.tngo of dinUv.s especially mongo er. vhic-.h an you know lock .Ukv a:.-diva wula.i* uiarasccp-:. `fj\;.<rdurs of s.,v-:r:l of the dvr! rr.ir.-.l:; wo rtu*io! in ih.: : as v-.y as a hum:; lung ai; .it van found that l.uadiu of .ponga spiruler; vcrc cvhvhkvi in the tissue:; of the blab l-:ra ir.vusti ; lud and w.nv no daunt resyenrird.e for ar.e iuiV*cticn. " < l. i . * -.`j ........ V.I . iJ.a e;.rir . r'u.ritis r.:ny : cviO thor.:;; is conum. I lv t Vu.: " oi th_- er;.':;^r. . au v- it'. all typas of pneer.oaen ins is, Vh - ri'l'r-.ry >. r rase le depCMi-.. i upon Vo assess accurately the deprcc of dm ii: ;y or l-v ;n ic evidence of clin-. A vorV.cr n.ay he disabled and yet sho nir.i.eal V.-r:y chimp-S. Conversely, there r,ay do aeiniual disability in,the presence of advanced X-ray chances. Diagnosis depends upon a History of r^;o~"ro, or/1 _ Sims and s'/mteus of rnsur.oconiosis. . The dicor.sc con dr cosily confused \r. U\ nulr.or.rr/ tuberculosis. It ruy also do i.\ist?.!:ea for r.-rny other lur.y lesions. However, there should bo no doubt of the diagnosis of a bilateral lesion characteristic of pnsur.oconiosis with or without nodulaticrt and a history of dust exposure to cirtcarceous carta. ' Tuberculosis can usually be ruled cut if no bacteriolopicnl proof of the presence cf tubercle bacilli can be obtained. If tubercle- bacilli are fo;uid and the other finfiir^s are as above, one rust diagnose the ccabia:! diseases. Pulmonary function tests .arc valuable in assessing disability. . Trvatrunl ` There is no cure known. Certain procedures such as positive pressure therapy combined with broncbodilutin" dru^s uav pivu leapsrary relief. (10) AluT-.ir.ua therapy or prophylaxis has not h^er. proven i: b: of value in ordinary silicosis and there is no reason to del let a d -..''.''aid bo ary '-.ere useful for Ok.tn::?.cc.0`is earth. There is ov.ypestive evidence that aiu'iiaus itself nay be harmful. (11,21,13) ' There have Ir'cn no reports in the li teratura of the effects of Z.C7.T or cor Ur vivo on this disease. Prem at ton Prevention of this disease .is 103f c.u-s.ildc, as is true of all occupational d 1: osu-.t-. It m r.ch.i-vveu by use of flu: r.aue print: oiler, or arc applied to other dust diceases. These are: 1. :'u\ i ran': Tin) cvnlrd;: a) Oteti.il >!' the dust '.V *;s s.iure-a by vent: 1... L ten ,*:-:d hods cficl'`..;u`e of piv-ia:.;.; --nl the .Idle. b) ViTi-ctiv? rrspirn ?r; ovry when bust cvlnt in n.'tl technic..tly po.:r.U*V'. ir. g :: rn L nr.'- .vt M s ' .U<r/ solu tion L.-C-u/.e they aw u.v.s.\fwTt,-.bl-.;, re,.* urn ':c;n-l wit i'.i'ivt, r.i'i'j f. l.j^L neL oiler. * ic'l ' .it. O Production methods rmy at tines be altvr'2 to rliuir.atc a tc:lo exposure. for cxv.rr le, one oi tho tlinlr/cacvs*-:: earth producing cor.panicG bon recently changed their csrioadir.q operation from an individual sue!: leading noLliccl tn the now rfficiunt end cleaner method employing :or>-liCt trucks, which life the sacks piled on pellets. ' 2. ?lrcic?.l controls: periodic physical examinations including chose X-ray and culmer.ary function testa to detect evidence of illness early. Good labor-rcri-f!onf!nt react'c^s* 1 2 3 4 a) Joint labor-nanager.ent health end safety committees which vorlc to assure intelligent participation ty ell personnel in safe and healthful pracciccs. .. b) Production policies which make it possible for the employees to carry' out safe practices. For example, in rm.ny industries employees arc paid ''incentive'1 wages to obtain rsojrsua produc tion* The employee, intent on earning more, tends to disregard safety precautions which slay his verb. This phenomenon is conmcn vherc pay is based on "incentive1' or "piece work.,; . Research heeded . Several questions about the disease remain not satisfactorily answered; 1. The precise level of dust exposure beyond which harm results. That is, vhnt should the "Maximum Allowable Concentration" bo? The M.A.C. is a useful tool in the public health control of occupational diseases. At present the ti.A.C. for quarts silica is used. 7nc evidence new suggests that if there is a change it will probably be lower for the processed forms of diatonncoous earth than fur quarts. 2. The precise toxicity and relationships of the amorphous and processed din Lenaccous earth dusts, 3. The relatienrhip of this dust to tuberculosis. 4. The true incidence of the disease iu both the producing cud consuming industries. /. thorough epidemiologic study is needed to provide the Heal Ur !V:vW.".vnt bureau of Adult H- nllh is csnm.encir..; such of otrru g v. u ,:wer.L 'l a;. -.-.c iv's :.i;d Ihe i: .1; ; trial -r-r.l nswars. The ot.ntc * study with live help at..I unions. G1.aniv 1 }'\0 lz'; Large air-containing rpnces in the lur.g which are formed by the fusion of ruptured air sacs, after. associated with wS,'yzc::z. o Calcine: Process of heating to hirh touceratures to h tin chemical reaction desired. 3 Dvscnca Labored or difficult breathing. 4 Fibronln: Atnor.mul ir.creasn in the growth cf scar tissue. 5 Flu:<: Chemical treat ant to hasten readier, desired. In diatc.mnccous earth processing, the chemical ordinarily used is sodium carbonate. 6 C-rnnulcaa: A -persistent overgrowth of granulation tissue, Granulation tissue is produced in the initial step of repair cf injured or diseased tissue. 7. M. \. C.: lixiuun Allowable Concentration, i.e., the maximum concentration of material in the air breathed during an o-bour uoilc-day beyond v.'hich disease nay result over a period of lino. S Pncursthnrrr: In accumulation cf air in the pleural spa ee which pushes in or collapses all or a part of a lung. A spontaneous pneumothorax arises from internal causes, and is often the result of rupture of an emphysematous bulla on the surface of the lung. 9. Fulmnarv ennhvsc~a: Distention and stretching of the walls cf the air sacs in the lung. It is found usually in the cuter parts of the Ierg which have the greatest capacity for expansion, and occurs as an aLten.pt to compensate for other parts of the lung v.'hich function poorly. PofrrO"c-*s 1. Luuu, A. 3., end I'^cvc, Ki.il, 1951. H-: iior- /gallic Minerals, 2nd cd., McGruv- 2. Cotv'u.uication froa Johns-Kanvillc Corporation, Dec. 26, 1931. 3. pJ'Jwyss'orVci, ii.: fcitr. path. Anat., 47, 270, 1910, quoted in Vigliani^.C., British J. Inuusir'. Med., 5_, 143, July 1943. ` 4 U'Cu^j .*1 ana Rcscncrmtc, E. by Di.atornceous Earth. 1932. ObsrTrr.t leas zr:l Stulles cn Silicosis Acer. J. public Health, 22, .1053, Oct. *5* Much, quoted in tlordhann. * .. 6. fiordrann, Martin: Die Slaublunr-g dcr Hi sscolruhr Arboiter, Virchow Arch,, 311, 116-143. 1943. - ,,- 7. Duvoir, H., end Derobert, L.: La Pneu.nacor.icce nor terre do daato::es etude evnerinantalc et clir.i^ug, Aon. de ned - leg., 27, 48-53, Jen.-Feb. 1947. - 3. Vigilant, E. C., and Kottura, G.: Diatcnaceous Earth Silicosis, Brit. J. Industr. Med., 5j 143, July 1943. - 9. .Gardner, L. U.: Feaction of the Living Pody to Different TVoss of Mineral Ou3ts, A.I.K.E. Mining Technology, 2_, 1-15, Kay 1953, Tech. Bub. 929. - 10. Killer, J, \u} and Sayers, R. R.; The Response cf Peritoneal Tissue to Industrial Dusts. Fublic Health Reports, 56, 264-272, Feb. 14, 1941* * 11. Jo:instonc, R. T.: Occupational Medicine r.r.d Industrial Hygiene. C. V. Mosby Co., St. Louis, 194'3, p. 333. 12. Examples of this nay be found ir. the following case records in the files of the California Industrial Accident Ccrjoission: LA 86-535 Hartnell LA 85-140 ihifcry LA 33-234 McLean LA 82-296 ilooner 5F 85-723 Lillies 112-556 KtO.abo 13. Voru.ald, A, J.: P1 atoaaconus farth Fneuroseniosis, Pros. ninth Internet. Congress Ind. Led., Bristol, :ng., John Fright, 1949. 14* jP-ath by Past. Search, Calif. Tuberculosis And Health Assrw, San Francisco. 15. Car. Francisco Chronicle, Jan. 13, 1952. 16. i! *.l ly 1, A tic--: IVrl.y v ;:r:: Mi lh- Fu .:or*onr. Vrnh-s, Aver. Indus t.r. Hygiene Assn. CyiarLerL/, March 1943. 37. Povniu;;, J, f,; C';.nee_r _of_r-; ip and Orel y.t.inncl Vrnwm, J. A:.var. M;d. Asm., J1//.9iJ 24,*J)/*f'- M *'. t Ait/s.-j.. ~ 19. Gardner, L> HReport, to Johns-Ma.v/ille Corporation or. six lun^s crcanined, . included in case of Hooper i.idLv vs. Industry, Li 32-29o. 20* Motley, H. L,; Pr.thol'vi red Phrp' oln^icnl Factors Involved in th-> Treatment of Sj.L'iooi:io m M.i-?re, Arch. Indusar. iiy{;ioao and Occup. Meti-, 3^5-373, Oct. iyjO. 21. Brown, E. VI., and Von Vir.klc, H,,; hprmrnt Statue of A.lurinun ir. the Thornor cr.d PreMy-lane-G o;.' I tliccs:::, J. Aner. Med, Assn., 140, 1024-1029, July 23> 1949. * 22. Eauder, E. W.: The Aliuzi r.uj Lur -rt 'Itechr. f. Cofallur.ed. u. Farufekrankh. 1949, Jure 3 nan Sept. 15, 42, Abstract in Bulletin of Ky^ier.e, 26t 2o6, March 1951. 23. Ivanova, M. G., and Ostrovskaya, I. S.: - Action of Alurlr.'iu Bust on Antral ` Orp.aninn, Hygiene ur.d Sanitation, Moscow, April 3, 1950. 24. Foitevin, E., Personal corruricaticn, Mar. 4, 1952. 25* Ar/iersen, U. M.: Uuoubiished talk before Santa Barbara County Hospital - staff Dsc", 14, 1950. ' 26. Anderson, W. M.: Diatcaaseors Perth rr.ov.r.occr.iouls, paper delivered at meeting of California Tuberculosis and Health Association, April lt) 1952, San Francisco. 2500 cc 4/7/52 \ ! - i *> / j 1 : .1 i A `1 ' i M ; f.` V? . V' ' ' ' // . /. ..fj ;iV-/` I ) / `