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FILE NAME Talc TALC DATE 1959 Nov 19 DOC TALC125 DOCUMENT DESCRIPTION Medical Journal Article - Toxic HazardsTalc Pneumoconiosis 1084 THE NEW ENGLAND JOURNAL OF MEDICINE Nov. 19 1959 admirers and should not be difficult of attainment The Herrman L. Blumgart Chair in Medicine will raise to the endowed list and still further dignify a program of medical teaching that has become at the Beth Israel Hospital under Dr. Blumgart an area of learning and research of the highest quality It will be the first endowed chair to become perma- nently a part of this important hospital Fortunately the inauguration of the Herrman L. Blumgart Professorship fund does not coincide with any early retirement plan with respect to Dr. Blum- gart himself His academic retirement is still two and a half years distant and long before that time his chair will have become an established fact Dr. Blumgart who became director of medical research at the Hospital in 1928 has been its physichief since 1946. He is also the distinguished editor of Circulation and a member of the editorial board of the New England Journal of Medicine Although Thorel presented studies of a case of talc pneumoconiosis in Germany in 1896 there seems to have been little interest in the disease in the United States until 1933 when Dreesen reported his studies of workers in the tremolite talc industry He found that many of the workmen had abnormal chest ray films that were consistent with a pneumoconiosis However in spite of the fact that a number of additional reports of abnormal films in talc workers appeared many students of occupa- tional disease were reluctant to accept talc as a cause of pneumoconiosis since so few autopsy data were available to prove that the pulmonary fibrosis was actually due to talc rather than to silica which may have been inhaled as a contaminant of the talc or in some previous occupa- tion Now however sufficient data have been accumulated to establish the fact that the pulmonary fibrosis seen in talc workers is quite distinct from that seen in silicosis Examination of the lungs in advanced talc pneumoconiosis shows that much of the normal lung tissue has been replaced by fibrous tissue containing many talc spic- ules Areas of necrosis with cavitation may occur in the masses of fibrous tissue In some cases fairly large rods resembling asbestos bodies have been found to be embed- ded in the scar tissue These have been called talc bodies Successful Treatment of Tetanus by Chloro- form The disease supervened eight hours after a wound from a pistol The remedy was administered by inhalation at intervals for several days with relief to the symptoms and the patient recovered Boston M. & S. J. November 24 1859 and seem to be associated with the inhalation of talc that contains a large amount of tremolite The fibrosis does not have the whorled pattern that is characteristic of silicosis The amount of fibrosis in talc pneumoconiosis presumably is directly related to the amount of talc inhaled Although talc unlike silica does not cause " proliferative reaction the retention of large amounts of talc by the lung results in sufficient fibrosis to impair pulmonary function seriously SOnCaIiEl TATIS MASSACHUSETTS MEDICAL SOCIETY TOXIC HAZARDS TALC PNEUMOCONIOSIS Talc is used extensively in industry as a filler and dusting agent Most of the yearly domestic production of approximately 500,000 tons is consumed by the follow- ing industries ceramics rubber paint paper roofing insecticide and cosmetics Although talc is the name for a specific mineral hydrous magnesium silicate H.MgSiOs in industry the term talc is applied to various mixtures of a group of minerals including talc serpentine dolomite and tremolite that have similar physical proper- ties though they differ in chemical composition Unfortunately some commercial talcs contain appreciable quantities of free silica SiO2 and may cause silicosis if they are not used cautiously This is one of a series of articles published operatively by the Committee on Industrial Health and the Panel on Child Health of the Committee on Public Health of the Massachusetts Medical Society The panel provides liaison with the Massachusetts Chapter of the American Academy of Pediatrics whose Boston and Worcester Poison Information Centers are activities of the Committee on Accident Prevention Thompson From the Committee on Industrial Health George F. Wilkins M.D. chairman Karl T. Benedict M.D Harriet L. Hardy M.D George E. Morris M.D Robert C. M.D Robert L. Quimby M.D and Henry F. Howe M.D. The ray findings in talc pneumoconiosis are not specifically diagnostic The early changes consist of some hilar enlargement together with an accentuation of the bronchovascular markings As the disease progresses rather poorly defined flakelike areas of increased density appear in both lung fields and finally these seem to coalesce into large dense masses In some cases the ray film of the chest has a dappled appearance suggesting the presence of many small blebs Cavities may occur in advanced disease A high incidence of pleural calcifica- tion has been found in tremolite talc workers Interest- ingly enough there does not seem to be a direct correlation between the presence of pleural plaques and pulmo- nary fibrosis The clinical picture of talc pneumoconiosis resembles that of other chronic pulmonary disease The onset is insidious with gradually increasing dyspnea A dry cough may be present initially but usually a chronic bronchitis develops and the cough becomes productive Hemoptysis may occur As with other pulmonary disease cor pulmo- nale may appear with eventual failure of the right ventricle It is not known whether patients with talc pneumoconiosis have an increased susceptibility to tuberculosis as patients with silicosis do There is no specific treatment for talc pneumoconiosis Control of the frequently superimposed acute and chronic pulmonary infections presents the major problem in the medical care of these patients Prolonged and intense exposure to talc is necessary for the production of a pneumoconiosis Unfortunately until recently talc has been widely regarded as innocuous The New England Journal of Medicine Downloaded from nejm org by JC JC METCALF on April 8 2011 For personal use only No other uses without permission From the NEJM Archive Copyright '2010 Massachusetts Medical Society All rights reserved Vol 261 No. 21 CORRESPONDENCE 1085 so that suitable precautions to prevent talc pneumoconi- osis have not been taken in many cases In view of GEOGRAPHIC DISTRIBUTIon of Certain Diseases The following diseases were reported from the com- present knowledge concerning talc pneumoconiosis it is obvious that workers exposed to the risk of talc inhalation should be protected by adequate exhaust ventilation or if this is not possible they should wear proper dust respi- rators ALBERT O. SEELER M.D. Medical Department Massachusetts Institute of Technology REFERENCES Thorel C. Die Specksteinlunge Specksteinlunge ein Beitrag pathologischen Anatomie der Staublungen Beitr f path Anat 85-101 1896 1896 Dreesen W. C. Effects of certain silicate dusts on lungs J. Indust Hyg 66-78 1933 2. Schepers G. W. H. and Durkan T. M. Effects of inhaled talcmining dust on human lung Arch Indust Health 182-197 1955 4. Smith A. R. Pleural calcification resulting from exposure to certain resulting dusts Am J. Roentgenol 375-382 munities named Dysentery amebic Worcester 1 Dysentery bacillary Arlington 3 Boston 42 Brockton : Cambridge 6 Chelsea ; Framingham ; Groton 1 Haverhill 6 Lynn 3 Malden 2 Marblehead 2 Natick 1 Peabody 1 Quincy 3 Reading ; Revere 1 Salem 1 Somerville ; Watertown : Wellesley ; Woburn 1 total 80 Encephalitis infectious Charlton 1 Danvers 1 Lunen- burg 1 New Bedford 1 total 4 Hepatitis infectious Abington 1 Athol ; Bernardston 1 Brockton ; Cambridge 5 Chelsea Naval Hospital 1 East Longmeadow 2 Fitchburg ; Fort Devens 3 Haverhill ; Holyoke 8 Lowell 2 Lynn 10 Malden 1 Medford ; Nahant ; Peabody ; Saugus ; Springfield 2 Stow 1 Taunton 1 Westover Air Force Base 1 Westport ; Worcester ; total 49 Lymphocytic choriomeningitis Cheshire ; Everett ; total 2 Malaria Boston 1 Meningitis meningococcal Agawam ; Bourne 1 Lowell 1 Lynn ; Medford ; Somerville ; Spencer 1 MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH COMMUNICABLE DISEASES IN MASSACHUSETTS FOR OCTOBER 1959 R^ SUM^ DISEASE Brucellosis ..... .... Chancroid Chicken pox Diphtheria Dog bite Dysentery Encephalitis infectious infectious infectious German measles ....... .......0 0... Gonorrhea .o.c..cc. cceceeee s cseeteseee seene ceeee Granuloma inguinale . Hepatitis infectious ce + Lymphogranuloma venereum ......... Malaria Measles + meningococcal . Meningitis meningococcal .. . Meningitis Pfeiffer bacillus Meningitis pneumococcal Meningitis staphylococcal Meningitis streptococcal streptococcal Meningitis undetermined Mumps seen Poliomyelitis . . Salmonellosis Scarlet fever Syphilis Syphilis 000... csc sen ee enero cee Trichinosis .. cec cee ce t. erres Tuberculosis pulmonary pulmonary Tuberculosis other forms Typhoid fever cough .....- Whooping cough . . OCTOBER 1959 0 170 1271 80 4 34 167 0 49 0 1 151 7 3 2 1 . okzynne okzynne okzynne okzynne okzynne okzynne okzyn e = ow ow - -- ------ -- S-- E-- VEN 1958 1 MEDIAN 1 1 1 251 264 1 2 1210 14 1107 14 2 2 96 59 212 212 0 0 25 34 0 0 0 0 109 76 6 5 4 3 1 1 0 0 0 0 42 10 183 404 5 109 45 23 102 110 210 191 1 1 117 145 6 1 121 121 COMMENT Diseases below the seven median were chicken pox German measles mumps poliomyelitis scarlet fever and whooping cough During October the incidence of scarlet fever was at its lowest level in the State's history With but one exception 1957 whooping cough was at its lowest level for the month of October in the State's history During October chicken pox and German measles at their lowest levels for this month since 1918 and were 1940 respectively Diseases above the seven median were bacillary entery infectious hepatitis measles and salmonellosis During October bacillary dysentery was at its highest dence for this month since 1942 dysinci- total 7 Meningitis Pfeiffer bacillus Arlington ; Chelmsford 1 Salem ; total 3 Meningitis pneumococcal Brockton ; Southbridge 1 total 2 Meningitis staphylococcal Worcester 1 Meningitis undetermined Boston 3 Dighton 1 Framingham ; Haverhill 1 ford 1 Somerville 2 Swampscott ; Cambridge ; Lynn 2 Med- Wakefield ; Worcester 2 total 16 Poliomyelitis Amesbury ; Attleboro 2 Boston 2 Cam- bridge ; Concord ; Deerfield ; Fairhaven ; Falmouth 1 Holyoke ; Medford 1 New Bedford ; Pittsfield 1 Quincy ; Salem ; Somerset 1 Springfield 1 Sutton 1 Waltham 2 Watertown ; Wellesley 1 Wenham 1 Westboro ; Worcester 4 total 29 Salmonellosis Boston 12 Brookline 2 Fall River 3 Leicester ; Lynn 4 Marblehead ; Natick 1 Newton ; Quincy 2 Shrewsbury ; Springfield , Worcester 5 total 34 CORRESPONDENCE OBSERVING THE PATIENT September To the Editor Dr. Dorn's article Some Problems Aris- ing in Prospective and Retrospective Studies of the Etiology of Disease which appeared in the September 17 issue of the Journal made interesting pleasplaean sat nt profitable and easily accessible even to one not properly schooled in these matters The nature of his paper delivered as a lecture in pre- ventive medicine on ways of learning about the occurrence of illness may not have permitted Dr. Dorn to dwell upon one distinction of importance in clinical studies of the natural history of disease This is the difference between observing one's own patients and studying hospital charts of patients one has not seen the term retrospective studies appears to apply to both these methods The study of disease is the study of sick people the more of them he has seen the better a doctor is other matters remaining the same Continual critical attention to all his cases the commonplace as well as the unusual continuously corrects or corroborates his clinical knowledge it strengthens beliefs confirmed by experience and shakes some that are not Medical books are a substitute for observing patients as travel books are for traveling authority properly belongs to the man who has seen for himself Chance combining opportunity and vision to see it may help a doctor find a few cases that resemble no known pattern but themselves a new entity is recognized and re- The New England Journal of Medicine Downloaded from nejm org by JC JC METCALF on April 8 2011 For personal use only No other uses without permission From the NEJM Archive Copyright '2010 Massachusetts Medical Society All rights reserved