Document 8RdpqORnaZn1dNkKGK4mjwVJm

FILE NAME: Sprayed Asbestos (SPRA) DATE: 1960 DOC#: SPRA013 DOCUMENT DESCRIPTION: Book Excerpt - Silicosis and Other Pneumoconioses Sweden AHUURK/iHLCC/.NVa-niOM nd O llier Pueiimueojiiobes in S w ed en and Ollier Pneumoconioses . IN SWEDEN 1^1 Q '*> Y \ IS, W& j? \?,V % SV K N SK A BOK T 6 R L \ r , E T Worsen,,jStuckhul,,, CVI . DF . NDAI . S Ki : HOC HANOI * L/ N O HD ! S K K >IU.A O ..........., AKAT F E M ] N r.N KI It J AKAi : I'l'A/ AK ADF MJ s K. A H O K t l AN D CI . N, H r h m f / ,, n U I U . 1 A M II FI N EM AN N LTD. / LomJon / r / .' CHAPTER 1. ASBESTOSIS coexistent pulmonary carcinoma. Con Since the beginning of the present ccn- cerning tuberculosis in asbestosis, opin $ - tury it has been known that inhalation ions differ. While, for instance, German v. of asbestos dust over a period of years sources reported that among asbestos $ gives rise to a progressive, diffuse pulmo- workers the incidence of tubercu \ f / L nary fibrosis, called asbestosis. This dis- losis was not higher than in the gener case therefore occurs in nnning and mill al population, British investigations ing of asbestos and in manufacturing showed this complication to he not processes using the mineral. uncommon, although less frequent that, The basal parts of the lungs are first in silicosis ( Worth A- Schhier 1957). -affected in asbestosis (Shull 19oo). The occurrence of asbestosis in There is also a reaction from the various industries has been studied in parietal and diaphragmatic pleurae and many countries. The first case described the pericardium, in which struclures secondary calcification occurs (Ahlborg in Sweden was observed in 1953 (Ahl Hansson 1956). As the fibrosis pro borg 1959). It led to examination of 60 gresses, emphysema and right cardiac asbestos workers and thus resulted in hypertrophy develop. The clinical pic ihe detection of 8 more cases (Ahlborg ture in asbestosis tallies with that in Mansion 1956). The prediagnostic other pulmonary fibroses; dyspnoea, duration of exposure to asbestos ranged !j f t cough and weakness usually are pres from 5 to 17 years; asbestos had been cut when the lesions arc advanced. used by 7 of the men in insulation work HSl In fatal cases the immediate cause of and by 2 in spraying operations. These death as a rule is given as complicating last 2 men had advanced asbestosis, bronchiectasis, pneumonia or cardiac 1 of them died soon after diagnosis. ) ft*1 The insulation workers had^ milder failure. Many investigations (e. g., Gloijne lesions. 19 3 3 > iP35i i)3G, Nordmann 1938, 1939, Ethrctis 1952, and Merewcthcr Technical conditions for asbestosis t&j;* 1947) indicate that asbestosis m tySL contrast to silicosis -- not infrequently &$' ics c(onmmpiiliiic.aatteedd by ciarcinoma or tlie t&Svlunc: in larre autooppssyy scries, between 'wj^-lO' and 20 per . . J' of persons with -u.'O-. asbestosis tons w r e found to have Asbestos (Greek, =, unquenchable) is the name given to mineral substance comp osed of fine, usually paraded libres which may vary m .englli from a 35 A lie ili u few microns to 13 cm1. In different types of asbestos the fibres differ in length, but as a rule they are pliable enough to be carded and spun into yarn which can be woven into tapes or sheeting. Asbestos belongs to the amphibole and serpentine minerals, whose best known varieties of asbestos fibre are actinolite, amosite, crocidolue (blue asbestos), tremolite and chrysotile. All are silicates but differ in composi tion. The most common are chrysotile. u magnesium silicate, and amosite, which is magnesium-iron-alumintum silicate. The silicic acid hound in asbestos constitutes about half of Ihe mineral's weight. Asbestos is mined mainly in Canada, Smith Africa and Siberia. Of the European deposits, the most important He in Italy, Finland and Germany. Asbestos is found in many places in Sweden, for instance in Dannemora in the centre and Taberg in the south of the country, but it is not mined. Some types of asbestos, because of their great tensile strength, high re sistance to and poor conductivity of heat, are widely used in industry. To insulate pipes, radiators, exhaust ven tilators, etc., slabs, tapes or braided tubing of asbestos may be used. When mixed with a binding agent and water ' Asbestos is ileflin'd in l l v British "As bestos I n d u s t r y Itegulations, UiMt" us ",niy fibrous silicate material, and any admixture containing any such material, whether crude, crushed or opened." .`154 asbestos can aUo ut. spread or sprayed on surfaces. In Sweden the use of asbestos has r&y increased considerably in recent years.'.^^ During a 5-year period before the iate-t*^ World War we imported a total .of^iSf. 17,000 tons, whereas after the Warp^J- once the accumulated needs arising from our isolation had been met, no less-api than 4B.50U tons were imported overy^j' a period of equal length (Ahlborg llanason 1956). A survey in 1955 showed!'^ that about (id Swedish tirms carried.-ir. out work with asbestos. Most of this sev work concerned insulation in the- yf - building and ship-building trades. Among the remaining uses of a .bestos -y* was admixture with various technical vfi products, for instance to make rein- -f forced plastic materiak.aud paste for treatment of automobile chassis. Manu- facttire and processing of slabs, blocks, etc. and sawing, grinding and polishing .<* of ashestos articles were also represente<hj The total number of workers involved was estimated to be between 300 and t ' Y 400. . Wrjb Many of the above-mennoned opera- lions, particularly spraying of asbestos, -.'A manufacture of sheeting and certain insulation jobs, are very dusty. To .-'ib eliminate or dimin.jh tile dust, wet substance is used as fur as p ' -sibic, and efforts are made to enclose the -A dusty operations ar.cl extract the con- /W taminated air by exhaust ventilation. When the dust concentration cannot be satisfactoriiv reduced, the workers can be protected by respirators. Not-Wf; Ty infrequently seems to has fairly recent icius arising seriously con OWN I AVES' I Our series n cases. In 8 contracted f from variou eluding spon linings, and with ,'sues11 was as folio case, 1955, i After the period (195, ashes tosis ! curding to muniention) tt]> to 1960 The age was begun r and that \vh from 35 to cases the showed mi finely -.nott with thickei pleura. In was r.dvanc irregular !i: hilus and r >"th lungs, were bulloi basal plem emphysema abundant a ' sprayed stos has - it years. ' ttic late total of 'h: War, mg from no less d over - ilborg S: showed carried of this----m the_ t radcs. idjestos i liiiica! e leinMe for M..HUi -ioehs, 11Iu111* ml ed. 'lived ' "J ;uiii "per.l- K, S| OS, Tl am ' * f 11 , '. wrt -,Me, 111" i .m- ...IlMlt "'hi rs Nut A * AjImmImik infrequently, however, prophylaxis seems to have lagged behind; it is only fairly recently that the hygienic prob lems arising from asbestos have been seriously considered. Plate XXVII in the appendix shows a case of severe asbestosis. The duration of exposure to asbestos ranged at diagnosis from 6 to 30 years in tiie insulation workers; it was 4 and OWN INVESTIGATIONS S years, respectively, in the men who made brake linings and 17 years in Our series of asbestosis comprised 11 the asbestos sprayer. The sprayer had cases. In 8 of them the disease was tiie most advanced lesions. He died a contracted from insulating work, in 2 few months after diagnosis, at the from various jobs with asbestos, in age of 63 years. The cause of death cluding spooling and weaving of brake was asbestosis plus pneumonia1. Au linings, and in 1 mainiv from spraying topsy showed, in addition io the ~ with asbestos. The year of diagnosis was as follows: 1930, 1 case, 1953, 1 case, 1955, 6 cases, 1950, 3 cases. acute changes in the pulmonary par enchyma, fibrosis increasing in inten sity towards the basal regions. Between After the end of our observation .period (1955) some further c,,.scs of leticuiar, slate-grey strands of fibrosis "etc spherical cavities up lo the size asbestosis have been dctccled. Ac of hazelnuts. The visceral pleura on cording to Aalborg (personal com both sides wa- diffusely thickened and munication) the total of known cases up to 1960 was 15. calcified. The right side oM he heart was hypertrophic. On microscopy the The age when work with asbestos atelectatic pulmonary parenchyma was was begun ranged from 16 to 52 years, seen to be studded with broad strands and that when asbestosis was diagnosed of connective tissue and foci of nodular from 33 to 63 years. In 10 of the 11 appearance. Within the connective i . cases the diagnostic roentgenograms tissue were abundant asbestos bodies. ?s showed mild interstitial fibrosis or 4 finely mottled infiltration, generally This was the only death during our observation period. After 1956, how with thickening or calcification of the ever, 2 more deaths have occurred from pleura. In the remaining case there asbestosis. & was advanced asbestosis with diffuse, No signs of tuberculosis or pulmonary *** irregular linear densities around the curcuu'ma "ere observed in the 11 hilus and down towards the base in men during the observation period3. both lungs. Between these densities were bullous rarefactions. There was basal pleural thickening and apical emphysema and the sputum contained r abundant asbestos bodies. 1 This ease wav described in detail by Ahl- burq Ilansson (l'.)j('d. ' After the oliservid inn period pnlmmi niv i *'iu r r \\;ib ItMiiwi in 1 c.tsi* A 13fj?55S M m .Hfe' M&S! Roentgenographic progression occurred in 1 case only. This was u 5t}-\ ear-old insulation worker with "at least 20 years of exposure", whose roentgeno gram 6 years after diagnosis showed increase of pleurai calcification ami of generalized emphysema. He had con tinued work with asbestos after diag nosis1. Two of the men received disablement benefit. One of them, the man who died, was compensated at full rate. In the man with roentgenographic pro gression, disablement was first assessed ns lo per cent ami later as iin per cent. DISCUSSION Although asbestos has been used in dustrially in Sweden for several decades, no cases of asbestosis were diagnosed before 19,10. Tin- reasons seem to have been manifold: a relatively long period of exposure to asbestos dusl is neces sary to produce the disease, and ex posed persons were not systematically examined before the first case was diagnosed; further, the number of persons at risk, particularly in the building industry, probably lias greatly increased in very recent years. Periodic medical examination or asbestos workers thus was instituted only towards the end of the period covered by our investigation (1931 to 1 In 3 other cases the disease progressed after the observation period. 19oi>t, ami not all the cases of asbestosis.*^ hitherto demonstrated had then been notified to the insurance authorities. v-j The cases we have presented therefore -uyfa comprise nnlv a proportion of those atw ** present known. They nevertheless show's if, that also in Sweden asboslosis may constitute a grave health hazard -V'*Among our 11 cases there were 3 deaths .-//$ from occupational pulmonary disease. rt- The time required to produce asbestosis was no mure than about 9 sears in 2 cases. A survey of ail asbestos workers m ... Sweden has iw n plannee; and should -"l. provbie further kuowhdge of the ri-k -jp of asbeslow 'Hie problem of nsl,(siosi>. is now bn?.'* ''!'/o'*ousiy utfue\''d bv Hie factory inspection authorities, and -.y we may anticipate that the risk wdl ' soon be reduced by technical pro pin taxis. l'o pi event a.sbestosis it is --* essential Hint technical and medical measures should rapidly be enforced. .<*? W . - ` *?S SUMMARY - Industrial use of asbestos has a fairly "4V'.' long history in Sweden, but asbesfosis iff" was not demonstrated in this country /vV 2 until 1990. After .Vhlbnrg ( 1956) directed' aw j attention to the occurrence of this disease, further investigations showed ,sr- that it was not rare. ra,<(t,*-r At the end of our observation period *& (1956), 11 cases of asbesfosis were known; the first was diagnosed in 1950. The work with asbestos hurl been m- siilutim of brai in 1 c: mortars and v.9 or cah.i rocnlg' lit no immar age ul \ ears e\posu One i rrlmi eurff/T magne the p1 dustrn and p talc, s the w< or lev. as str.i soapsi Comm small 1 pound etc. O quart t t oce is too nsbestosis iJlCll b e e n tli r>ri\it-s. therefore f tliose at less show oSis may hazard. 3 deaths disease*, isbeslosis 'ars in 2 orkers m d should tin*, risk she stosis irked" !>v lies, and risk will <nl prosis it is medical ufurcrd. a (airly bestosis country directed o! this S.1U". oil i period is were in lb'a. M'tll 1)1- sulating ojierations in S cases, making the oliscrvatioif period' and in another id brake idlings in 2 cases, and spra\ ing case there was rocntgenographic pro in 1 case. In lo of the men the pul gression. Disablement benefit was monary fibrosis was mild at diagnosis awarded m 2 cases. and with or without pleural thickening This investigation, despite its limited or calciiication. The remaining man had scope, indicates that in Sweden asbe.s- roentgenograplncally advanced disease. tosis is an important occupational In no case was there coexistent pul health risk. Strictly enforced technical monary tuberculosis or cancer. The protection and medical supervision of age at diagnosis ranged from 33 to 03 exposed persons are therefore necessary, years and the preceding duration of especially as the use of asnestos has r - exposure rront -1 to 30 years. considerably increased in the past :vr*. One man died of asbestosis during decade. t'- CHAPTER 2. TALCOSIS i. --- Trchnical conditions for talcosis and cance. In analyses by Schultz A Wil earlier observations. Talc, which is a liams f l `j-12) 25 specimens of talc were magnesium silicate, is widely used in found to be free from quartz, 25 con the pharmaceutical and chemical in tained traces of tins substance, and m dustries and in rubber, cleaning mat crial I there was 3 per ceri* of quartz. In and puper works. In the deposits of specimens of Swedish soapstone we talc, which are lound over much of tailed to demonstrate quartz with a ihe world, the mineral occurs in more method that gives reactions down to y- or less compact form, ami sometimes 1 per cent of the mineral. Almost with $VI*. as stone, as shown by the designations out exception, industrially used talc soapstone, speckstein and potstone. is in powder form and frequently it is ;> Commercial talc trequently contains milled near the. mine. The dry, light small quantities of closely related com- talc dust everywhere present m the^c pouncs such as tremolite, anUgonte, mills is a troublesome hygienic problem, etc On the. other harul, admixture oi ft quartz is relatiselv rare, and when 1 Af l c r 14.'n ttiore wort. J n:<>rC t e n t h s . il occurs the content of free sdi c a ! frnm nv|*MrKis n'onf* r-D>! ) f;i'M uvs f is t oo low to be of pathogenic signifi with pulmonary caiicir.