Document 8OVQNw1jeZ6Ezxmnn40LN5enk

FILE NAME: WR Grace (WRG) DATE: 1939 DOC#: WRG238 DOCUMENT DESCRIPTION: 1939 Journal Article - An X-Ray Study of the Lungs of Workmen in the Asbestos Industry, Covering a Period of Ten Years. Published in Radiology, Volume 22, Issue No. 2. With Annotation regarding Absence from WR Grace files. V AN X.RAy STUDy Or the lungs o f workmen in the asbestos i n d u c e s COVERING A PERIOD OF TEN yEARS' * - . A HL\L W. OEORC.E. M.t> itnj R A L P H IV LK**XARI>. M IV, fl#.</*, L'isT inhalation is a subject in which cider.t boards, and also as a we have been particularly interested for the past ten years. Our approach to this problem has been through the medium of the x-ray During the past dition in the individual, it* pathology aaj ^ prognosis a observed by us through the ^ *> * In H>2>. we began the intensive study five years, the dust hazard in many in dustries has become a serious economic fac tor. for the individual workman as well as those*exposed to the asbestos h azard * one of the large industrial plants in Mass*. chusetts. where brake lining was for the corporation ami insurance com factored. The hazard created veas pru*> f pany. In some instances the amount of alleged disability among the workmen, from dust, had reached such proportions that pally asbest. with less than :> per cc ? silica. Dry weaving was first used uxi . then changed to wee weaving. This insurance companies became insolvent, and was brought about by the fact that in 19 . the industrial plants were forced to close and 10*20 there were numerous cases . for lack of compensation insurance pro showed symptoms, referable to the lungs. * tection. characterized by increased d!5 cul.y a * During this period, we have had the op breathing on exertion, cough, sleeplfesao* portunity ot studying the chests of over and loss of w eight.. Of all the cases e*-o_ three thousand workmen exposed to a duat examined in 1`.>2S and 102V. our records o-- hazard in their regular occupation. This that in 12 cases x-ray examination reveled group included various types of dust haz change* in the lungs. upon which fcssrd ards--mining ar.d manufacturing --and our ci:ugV.O-i- u* asliestosi* These 12 *ttt from various parts of this country. eu*c o: at once put on compensation or rives * the Rockies. Fr*.*m this gr>up it ha- beer, lump -urn settlement and have keen sad* our privilege to observe with the x-ray the observation f.r .-evc-n year, throwing <o*> change- in the chec which may result from .rfrrabtf Ugh: **r; the natural p w e B d more or !o-- continuous e x p lo r e to var>-u- the disco.-.-. From about P*-n to I*JHL rvnes of du.-t. such as silica, talc, marble, we routinely examined tho-e cx-<s * coal, asbestos, heavy metals, such as iron pecteti ciinu-ally of asbesto-i. By l?3 and brass, and various organic dusts, such the insurance premium had pyramided as wood fiber. In per cent of the payroll, and the auriarv In this rather cursory paper, it is our were rather indifferent to the taking a* ^ purpose to record our ob-er.-acier.s and this ri.-k Finally, one of the large a m conclu: ions based on an x-ruv studv of or.e paniv> decided that before they took e type of du hazard, namely. a-fH-tu- thi* ri-k. they would have exaassrL dust The disease cor.dition rvuttir.g fro-- clinically and by x ray, all of the emriorres the iuhnlctiMi of u-bv-to* du-t is that form of t!u plant tra ilin g approximately of pnv msornttio-:- knw:j a? a-,*--v-:* hundred Th- majority these aerksr* ^ Wv -hi.il '-.rmurnt on tbi- dt?vu--. a- a:i w*.rv t\.i:ninl b\ u- immedsateiy ^ ** con*mi* prflm-m. a- it von *.-rn- tin- in- plant Theft- w;ia a w ry nursbff d 1 surumv companic- and the indu-trial a. thv total employee- who-e * diagn*-4tl a- j-b--to-j- ( >u( * this ^ * Kv<tl fu j :*: i U iiiM 'iiim t a t 1 . rt* . i ur:*. bet that *.\v tr*l r du^***^ Antuu.1 M i t ii n j nf th --.-.!\ \<f*h A m .iu a , t Z ii i.U f ;l i. N'*v > . * Th- i- n>f >4 -rrr u i irai-ur. ! (*w-t..|. 4iul f.riim r p:;vi. >4 t S-t! H ii-vli. >; i t * a-bv-tod- tiler- lurt.- three i'JiO ^ ' definitely ad-.-.uu-.-l 1 thtT* wTv f ;nt* rv-t !v> :- t,'u*c did ao* AC W. R. Grace & Co. received this docummt on July 27, 1985 Horn tH. pl.li.tlff .. . trial axhibit in Qtoenville Countv school pT a t . v. o . s . U rn. GypsuM Co., et al.f C/K Ho. 82-3142-1* (U.S.D.C. South Carolina). Ho copy of this document has been ... . 1 ; PLAINTIFF'SEXHIBIT found in Grace's own files. (S tlr L r.Ki'HUK a m * 11 *N.\KI>' Lt.\i.> IX .\-HK-in-. fNIM'M'RV t!C .Sr & xE- -2r`- ttc u*u.il clinir.it sgrts: and would s: mnt of the hi>:ii wage* they change their occupation, !u*v t- -tv men continued to work until .L.r.t was closed, in l*.:?U. One of the ! Y^.ur.e a litigant later. The other appeared into other industries and ... recorded as claiming disability to 4 A '-r*. <>* oi this type naturally revealed .,r v interesting lung conditions aside -.aa-'e-tosis. such as aneurysm. early .^!id active and chronic tuberculosis. . abnormalities, "and many cases of changes from previous lung dis- l!u ant was eventually sold to a com- ;-.v company and was immediately * ,? Within a short time after the clos plant. WJ workmen brought in '..:a- for disabiiitv due to asbestosis. cases were examined by us by x .. or.*I we made a positive diagnosis of on 12, with three additional . . . q::e-tionable. About 12 per cent of :---:*.:ve x-rav diagnoses, in this group . ri.iimed symptoms of asbestosi. a.-'.:ra:;ce carrier for this competitive ; immediately placed these 12 . . . . .:.*r on compensation or they were p-sum settlement in excess of * The diagnosis was based upon '::.\.1 and the x-ray examinations. * *. ;.i!*.;. the x-ray. There were left 7S - - tuning disability, but their physical * * x ray examinations were negative. *th: cri.-un of 7$ claiming disability, but ' physical or x-ray evidence of * * came to trial. There is. in *!t" the Legal Aid Society which *'*' able counsel for the plaintiff, as * :::;* t-nc medical experts A very ittornvy wa- cho-ett for these ' *! the late John B HaweJ J r . : medical expert He. in turn. : - l.lkeMi cases hot!', dinirally and *ti these ill* cast- he made a Tnder our Statute of ' *; ! l>iea-es of tht State *>f M assi * " t'.te >o called " I 'unvl P'-ctor-.'' : ; tf;rvv. one of whom is a ront genoltigi-t Ihider our State l.aw their diagnosis is linai. They had the oppor tunity to examine l of thce Ull cases. Their reports in no in.tunce definitely Stated a>hestosi>. but their findings were reported as. "consistent with." or " a slight degree o f." or " the probability o f asbestosis It was obvious in reading their reports that they were not depending on x rav findings alone, but were giving the benefit of the doubt*to the workmen, in many instances being influenced by the history of exposure. The x-ray films of these cases which were diagnosed as posi tive by the Panel Doctors, we would have called negative. This illustrates the great difficulty in interpreting an x-ray film, as to the presence or absence of lung changes due to ashestosi. In many instances it is a matter of personal opinion, and the value of an opinion is in a large measure in pro portion to the roentgenologist's training and experience in this specialized field. The late John B . Hawes. Jr.. M .D .. who was one of our distinguished specialists on tuberculo-is. always forcefully expressed his opinion regarding an individual who worked in a du.-t hazard, claiming that ex posure for three years or more made the individual a potential ease of a.-be-tusis. He so expressed himself when the-e cose'J came to trial. We all felt that at least N. per cent of his positive diagnoses depended upon history of exposure rather than sub jective or objective physical signs. We will not attempt in this paper to take up the question of physical diagnosis, but we will say that it is our firm conviction that at the present time the only method of positive diagnosis 5 the x-ray. and that a.-idc from, the history of exposure there' art- no clinical pathognomonic sign- of the di-ease. The clinical fart- .it whi h Dr H iw o ha-vd his diugno-i- an*I pr<.-grio-iof usbesto-;- were as follow;' i I/ hi-tory of e.\po-ure. 12 difficulty in breathing on exertion; (U- cough, f4 > rapidity of heart action on exertion, and (.*#; tha taliv-t >* w;o* a progrr-sivi- disease, once contracted:, whether the individual remained in the indu-try or was removetl. W. R. Grace & Co. received thia document on July 27, 1985 from the plaintiff a8 a trial exhibit in Greenville County School D i8t. V. o . S . gypsum co^, e t a l . , C/A.Ho. 82- 3142-14 (U .S.D .C. South C a ro lin a ). Ho copy o f t h is document ha been found in G ra c e 's own f i l e s . PLAINTIFF'S EXHIBIT , 1 W* R* Grace & Co. received this document on July 27, 1985 from Dist. v. U. s. Gypsum Co., " the plaintiff as a trial exhibit . a1 C/A No. 82-3142-14 in Greenville County School (U.S.D.C. South Carolina). 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P a c rtr p-4 " ? c . p* P . uV r ^ 3 ~& C * 1 a * M 2 35- a- O S, (*/ C n a o * a :i p* c a M Mn . --o tr /.. r- i< f :i t1 A m . 1 1.1 : q * p 3. CV ^; ---:iI ; : ~ ar c |f. n p- rft - JT n r # # s A # : m p X n s- a 1 f ; ;i ? 'T A Xr# l* r O a y- r, * ri V.* w. R. Grace & co document on July 27, 1985 from 4. the plaintiff as a trial exhibit 1 in Greenville County School Dist. v. o. s. Gypsum Co.. et al., C/A No. 82-3142-14 (U.S.D.C. South Carolina). No copy of this document has been m found in Grace's own files. m Aug . Un.Mty m charactcri/.ftl first l>v bit.itcr.it di>trilmtkm. arui. se-condly. by its being limited to the lower lobes of both lung? The quality of the shadow is characterised by a homogeneous quality'Und is described ir. the literature as a "ground-glus?" or "sm oky" appearance The rr.icro-cc.-pie changes in the Jung show that we are deal ing with an almost interstitial fibrosi- with ureas of aM tctasis of the alveoli and smaller bronchioles. There is an absence of the gross noduiation seen in silicosi- What nodulation there is has a fine, evenly dis tributed quality. There are no character istic changes about the root shadows. Some cases are associated with hilum fibro-is a;ul glandular enlargement, but many ca-v of a*hesto*i *h>>'A rio variati- -n ir. the appear ahe e of thr hi! unt -hado-.tL *i'. n tin re i- sonie ive- <*t tti l*r- -tic!itia l sh:i do WS The * ir*.-u-:;t le found a pccui!i.ir ar i ' rifa :u e .: the b f fl filial tree in both towf Io! i -. ir. that it p.re-'ent* a tukiller lai itili: tl-d appe-.tran-Jf '[ bis p-vuliar arrangement tin- i-r-r.v!:iul shadow? i- apparently da to l*-uli/f.-d area- of emphysema scattered thr--u.,!:--ut the lower lobe* The n;i Toa-op.. till. w. tl af th h.i-it patitolo.;1. ehanc- i* tin de-p**-il of- a protective element about the a*be-to> liber, rather than a destructive, p rove of the lung tissue. The asbestos v fibers appear to be surrounded by a sub--ti stance uniform in character and having-^ the appearance of connective tissues. It - would appear from a study of the ilidesJj that the fiber is innocent of producing,__ an y pathologic disturbance, except aa^ is impedance to the air in this region of thei^~ lung In other words, in aabestosis wei are dealing primarily with an atelectasis due to the mechanical blocking of the! alveoli and bronchioles by the protecting 4 fiber* alnjut the asbestos fiber. This; peculiar, diffuse microscopic fibrosi*. as-idjr sx,iated with atelectasis ar.d microscopic areas of emphysema. is the type of change that produces the so-called " ground-glass appearance on the x-ray film. -Sj In .the .second -.place.. asbestos dust pro:^L. duces changes in the pleura, the most coa- * star.t finding being an accentuation of one ^ or more interlobar pteur-.l septa. The^- rr.icroscope show? chat fi* oris associated v.;th the asbestos fibers is .rone to involve thv plvuraNctivering of the lung The dsnior..;ratio-u o: pleuritic adheii-.ns of * both lower chests, with obliteration r i the costo-phrenic angles, is a rather cor.-tant ' finding in uncomplicated nsbestosi.. -- In the third place, the x-ray show* the .. usual signs of emphysema. This ea-a physema. of course. i< not pathognomonic^ of asbestosis but when accompanied bysfc other x-ray indications-, can be considered. . of a confirmatory oature. This evidence^ of emphysema is best demonstrated by t a e v limited excursion of loth diaphragm- and-- the increased radiabillty In the fourth p!a . of uv thhaevleu rne--*tr ' *! < the t u*e- of a-N -to?:- Certain oh -a-* the entitour of th< hear? sh.ufl-.F whi h *t-. fee! i* somewhat e'avadiy relate1! t- tne proev in the lung Other write.** h* --e` put et*r:i<Ierable mphuM-* nn th dilatat:-.-.* f th rigfst aurie! au-l veni rivi deite- /i a*!>t(w* Il i* *our |:ni,'r.-t`saS*Pl dilutatiou of tilt- riglit *iilv oC th- bear*, -<*n iti u higher p<re utage of u-l-e-l--4**-. c a - than in ot!;.-r fortn-* tf pncntif- ,, HAINTIFF'S EXHIBIT, t Q V k J lf ) . j 7 r* r I* 7 r. p 1r-, r* r 1* S* . ,, # :' r ci *, rtft* r*/* cn p . 4 r* # J N P u ft- rr y* Pft re 1. / 7' r* 1* rJ 7 rr 9 r* ' ** ft rt 5 i ~~ 3 Z 7 a r ~ . 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"' ' 5X M fL** o< :> ^ p 2. t- s 1 P I: : < *o ft j E = * s .jf n a. 3a-> 3 m 3 00 O. c n 7 <, V p 2 .2 *i u -' >.V,f&: ^ ' J ( '1 S rt ^ *. P r*..Rt O T) 3 r. a - ? ai -r r5i*` m w 3 2 *o ;i f- n r 3 a. * r*v t ^ ? Jr 3 3* / S l . 5rt 3 1 3 P " 3- 3 o r P A - 3* ? r* r# n> P < r 3* 3* -- u w rt if m -- 3ft* 1 1 *1 7 %2 %3 ft ft 2 T mi S1 p y o ',j a i* rJ ?M8- i| l* X r-* .* it < # v '. * . * , . * : :1 * * : v - *i!* * A * ^ # ft/ ,r - /.v `l */. * * i r.t * -j ** ... Pt 3 a *. p ~ 3* X /*. V r f 5- i i p ft ?- ft r t s; 1 < ?* rP? r'* ? 5 ' / : JL. / V ^ *rt :i o. a r-. 3 --a n3 s :.a v rt 3 ~ S= a -; o 3* 7 ? *? r j C cr. fSt* --7 --3 r p o ? 2, i 7 2. r-. r* - c 7A <.*.. X / 'i 7 T 7 A 7 1^ W* R. Grace h Co. received this document on July 27, 1985 from the plaintiff ae a trial exhibit - P t 4.l*rp- I a' in Greenville County School Dist. v. U. S . Gypsum Co.. et al., C/A No. 82-3142-14 (U.S.D.C. south Carolina). No copy of this document has been found in Grace's own files. 1 *7: SiS S rw r bronchial >hadows in the lower tohe- Chronic passive congestion associated with heart lesion might well simulate conditions of asbestos*. The differential diagnosis in such an instance depends considerably upon the clinical history. Chronic bron chitis or bronchiectasis might produce a picture somewhat contusing with asbestosis. but neither of these conditions usually shows the characteristic "ground-glass" increu>cd density over the lower lobes. C 'S 'CLfStoNS ( li It is our opinion that every in dustry with an asbestoses hazard mu>t be a special study in itself. All a-besto* min ing and manufacturing cannot be classified in one group a? to the dust hazard. The percentage of silica in the asbestos dust mu>t lv tak.cn into consideration, method of manufacturing, whether it the dry or wet method, i* of importance, I2.i We are of the opinion that the dij3 *. ease, asbesto-is. is not a progressive dis$` ease after the individual has been re. re moved from the dust hazard. There is no evidence in our study oCL^ asbestosis for the past ten years tha^- ashestosis .has any causal relation tuberculosis. ' 4 ; It is our opinion that the final diag nosis of asbestosis must depend mainly 01 the x-ray evidence, that there are - a ^ ' clinical finding* pathognomonic of .asbes-2 tosis. and that an amount of asbestos dust'^y. in the lungs, sufficient to produce syma-fc toms, will give visible evidence of tisiu*^, changes on the x-ray film. .a t W. R. Grace & Co. received t document on July 27, 1985 fr, the plaintiff as a trial exh in Greenville countv School ^ v. s a s TM Co., C/A Ho. 82- 3142^14 (u .s .d .c . south Carolina), i copy of this document has be! found in Grace's own files. - # i