Document 6BREK1LJpzELJevgvJE1we1xE

o PLAINTIFFS EXHIBIT " . AB-77 Chest Conditions Simulating Silicosis L. E. HAMLIN, M.D., F.A.CS* Medical'Director, American Brake Shoe Company, Chicago N recent years the recognition of true occupational is questionable. A few cases have been reported from I fibrosis has become more difficult because of an Eastern .textile mills but after a vqry thorough inves ever increasing number of conditions which produce tigation of the cotton industry iri Mississippi in 1944, patterns, in the roentgenogram resembling silicosis. Ritter and Nussbaum were unable to demonstrate any These are by no means confined to diseases caused by x-ray findings characteristic of the disease, either in the inhalation of dust but range, all the way from cer employees in the cotton mills or in the files of private tain heart afflictions to the exaggerated linear mark roentgenologists or the State Tuberculosis Sanatorium. ings representing vascular changes in the lungs They did find certian allergic individuals who showed associated with advancing age.- Their careful ap very definite asthmatic reaction to higji.concentrations praisal as a health consideration as well as an indus of cotton dust, but otherwise, clinical evidence, was trial complication therefore becomes more essential lacking. Postmortem and histological examinations re as new complexities appear. vealed nothing of a specific nature. They concluded The following classification of diseases whose x-ray that "no evidence was found to clarify or even support pattern may be confused with that of silicosis is offered the existence of byssinosis as a clinical entity arising not as a complete listing but as one which includes among employees exposed to Upland cotton in a cross those derived from a search of the available literature. section of that industry in Mississippi." Mycotic infections -have been placed in the non-indus Bagassosis is.the name given to an industrial disease trial group because the. majority of them occur without observed in a few workers in the sugar-cane industry. any relationship to specific occupations. However, they The disease is described by Castleden and Hamilton- do result, in some instances, from occupational ex Patterson and also Gillison and Taylor in the British posure. Medical Journal in 1942. They state that "bagasse," a waste product after the sugar has been extracted, is Chest Conditions Whose X-rays Simulate Silicosis A. Industrial I. Organic II. Inorganic . - (a)' Byssinosis <b) Bagassosis (c) Tabacosis (a) Anthracosis (b) Radiopaque Deposits--. . Barium (Baritosis) used in the manufacture of board. The material is crushed or shredded into small fragments, the fibres of which contain about 1% protein and 5 to 1%. silica. Symptoms after one to two months' exposure, con sisted of dyspnoea, cyanosis, violent cough, scanty sputum, occasionally blood streaked, and mild eleva tion1 of temperature. The .x-ray suggested a bilateral pneumonia of the influenzal type which either resolved (Inert) Iron (SideTOsis) completely after several weeks or left the patient with Tin some degree of residual fibrosis. As in the case of (Toxic) (c) Beryllium (Proliferative) (d) Asbestosis B. Non-Industrial 1. Mycotic (a) Aspergillosis (b) Moniliasis ' - ' ' . (Yeasts . .(c) Wood dust spores . . and (d) Coccidioidomycosis Molds) (e)' Blastomycosis (f) Actinomycosis II. Miscellaneous (a) Miliary tuberculosis byssinosis an allergic response in the lungs to this dust was a definite, possibility. .. , Tabacosis has been .described. as far back as 1865 as producing disease in the-lungs. However, very few cases seem to. have been reported. In Argentina-and Brazil the condition is considered an occupational dis ease and is compensable. C. F. Long, after a period of 10 years experience among 4,000 workers in the tobacco industry, made: a special investigation, of over 1,247 (b) Sarcoidosis who had been subjected to tobacco dust and compared (c) Mitral Stenosis . - them to. 1,007 who had never been exposed. He con (d) Cancer (Metastases) (e) Vascular changes (f). Miliary calcicosis (Wheatena) (g) Polycythaemia Vera cluded that "Tabacosis does not develop in the lungs of those who inhale tobacco dust." Some inorganic. dusts produce alterations in the lungs which are represented by a mild accentuation of Since the year 1818 certain pulmonary conditions are believed to have developed as a result of exposure to dust in the cotton industry.- Reports from Europe as well as from this country indicate that prolonged ex posure to high concentrations of cotton dust have caused definite symptoms and permanent'disability. In England the Byssinosis Act of 1940 awardfrcompensation for total disability following periods of exposure in cotton mills up to 20 years. In the United States the existence of byssinosis as an occupational disease the linear., markings in the x-ray. Included in this group are dusts from such materials as limestone, marble, talc, chalk, calcined magnesium for insulation, furnace linings, carbon and cement. Since they are relatively inert and non-productive of symptoms, their presence is only detectable by x-ray and the shadows observed may resemble the exaggerated lineal pattern of pre-silicotic stages. Dusts from substances like barium, iron and tin, can result in radiopaque deposits in the perivascular lymphatics and interalveolar septa which cast shadows Preacntcd at the Annual Meeting of the American Association *>) in the roentgenogram closely simulating those of dis Industrial Physicians and Surgeons at Chicago. April II. 194$. crete, nodular silicosis. The deposits have real sig- SPNY 000235 -^ nificance from the standpoints. Mitigation but are of publicity it has ;ived would indicate. A hydrated no apparent consequence as far as health or disability magnesium silicate, it is believed to produce its effects is concerned. In 1938 Sander and Enzer described through mechanical plugging of the alveoli by long findings in welders who had no known exposure to fibres (over two microns) which have an irritating silica but whose chest x-rays showed marked nodula- effect on the lung tissue. There is some associated tions almost indistinguishable from silicosis which fibrosis which is responsible for the characteristic were demonstrated to be the result of inhalation of ground glass appearance observed in the roentgeno iron oxide fumes. The borders of these shadows were gram. The greatest occupational hazard exists in min generally more sharply defined than those of silicotic ing, handling and crushing crude asbestos. nodules and the hilium shadows less prominent. Post Fungi are filamentous plants of simple structure mortem findings on one case, who died from accident, which include a variety of yeasts and molds capable of gave no indication of fibrosis either grossly or his producing disease in the lungs as well as in other tologically. On microscopical section, deposits observed structures of the body. A common fungus, aspergillus, about the blood vessels were simple pigmentations consists of many species of molds one of which, asper- which gave the typical Prussian Blue reaction for giilus furaigatus, attacks the lungs and is responsible iron. Development of clinical symptoms and suscepti for the disease known as aspergillosis. Monilia albicans, bility to complicating infection were lacking. a yeast-like fungus, may produce primary lesions in In recent years our own experience with foundry the lung or sometimes gain access as a secondary in grinders and burners seems to indicate that much of vader. Infection with any type of this mold produces the nodulation observed in films of men working at "Moniliasis," a disease which may affect the skin as these occupations does not represent actual silicosis well as the pulmonary structures. Coccidioidomycosis, but is the result of excessive exposure to iron oxide, Sporotrichosis and Blastomycosis are due to yeast-like similar to that described by Sander. Clinical findings organisms which generally cause a progressive infec and occupational exposure are not consistent with the tion affecting the mucous, cutaneous, subcutaneous, present conception of silicosis. The analysis of 'repre osseous and visceral structures. Involvement of the sentative samples of air borne dust by x-ray diffrac lungs does occur in some cases directly through inhala tion, petrographic and chemical examination (over a tion of spores, and sometimes fungi may be superim three year period) indicates that there is not enough posed on existing diseased area. free silica in the atmosphere to constitute'a definite In 1931 Towey, Sweany and Huron described a pre hazard but enough iron oxide in finely divided form viously unrecognized disease which occurred in 85 does exist to produce the pattern noted in the x-ray. workers who came in close contact with dust from Experimental work is now being carried on in an effort } .maple logs. The logs had been cut for more than a year to determine the effects of this particular dust on and were not disturbed throughout a hot, moist sum laboratory animals. mer, a circumstance favoring fungus growth. The A comparatively new disease entity caused by beryl dust, which was of the consistency of lamp black, ac lium and its compounds has recently been established. cumulated beneath the cork layer of the bark and was Beryllium is a strategic metal which was of consider liberated during peeling or sawing operations. On ex able importance during the war in the production of amination it was found to be pure spores of a fungus precision instruments. The exact effect of this metal on -tentatively classified as nummularia or coniosporium the tissues of the body has not been determined but corticola. its action is thought to be a toxic one, producing der Symptoms produced by inhalation of the spores were matitis, nasal irritation, skin ulcer and chemical pneu aeute and asthmatic in character. They included dysp monitis. Van Ordstrand and his associates have re nea, cough, loss of weight and expectoration. The con ported their observations and findings in 170 cases of dition was considered an allergic response to sensitiza poisoning among workers in the beryllium industry. tion by the fungus combined with a possible toxic ele They noted that the disease was not limited to men ment in the spores. in one type of work or in one phase of production and X-ray findings were proportionate to the degree of the incidence and severity were proportional to the dyspnea observed and consisted of definite mottling degree of exposure and chemical irritation of dusts throughout the lower halves of the lungs with in and fumes. The chemical pneumonitis which developed, creased hilar, basal and trunk shadows. Peribronchial in 88 workers represented the .severest form of the markings were increased throughout both lungs, ex disease and progressed without exacerbation Or remis cept in the. apices. Physical improvement with clearing sion, either to complete recovery or to death. Roent of the x-ray occurred in all cases within two to three genologic changes in the lung fields did not appear months after removal from exposure. until two to three weeks after the onset of symptoms The general characteristics of mycotic infections of and physical signs. Changes were bilateral and diffuse the lungs are sufficiently alike to warrant their con in all cases and varied with the severity of the disease. sideration as a group. The x-ray findings may show In order of appearance the changes were (1) diffuse some variation, as they do in silicosis, but usually they haziness of both lungs, (2) development of soft irregu range from accentuated linear markings to miliary lar areas of infiltration with prominence of peribron sized densities which may coalesce. Advanced cases chial markings, (8) absorption of soft infiltration and may show discrete nodules scattered throughout the appearance of discrete large or small conglomerate parenchyma of the lungs. The differentiation from nodules scattered throughout both lung fields and (4) silicosis, tuberculosis, metastatic cancer, sarcoidosis, clearing of the lung fields after one to four months. etc., can be difficult and diagnosis in individual cases Necropsies on five patients showed' a typical pneu should be based on correlation of clinical evidence and monitis. Fibroblasts with evidence of organization exposure with the roentgenogram. were present although in patients who recovered, no. Diseases such as coccidioidomycosis are endemic in fibrosis was evident on roentgenologic examination of some localities and while no* region is exempt, a higher the chest. incidence occurs in certain areas. There does not ap The so-called fibrosis due to asbestos fibres in the pear- to be any occupational prevalence, but cases of lungs has long been recognized ? ' i occupations! nr cotic infection do occur in certain industries. Re- ease. It does not seem to oco- ireque^r vntly a case of primary bronchopulmonary aspergil- SPNY 000236