Document JJ5k0X19wXzaZX0krbR4gnB1X

FMES1NALD H. SMART. D. 1136 WEST SIXTH STREET Ln AW3CLBS. - CALIF. March 1, 1951 Dr. A. J. Lanas, Director Institute of Industrial Medicine lew Tork University Bellevue Medical Center 477 First Arenas Hew Fork 16, Sew York Set Aluminum Treatment of Diatomaceous Sarth Pneumoconiosis, Dear Tony* Thanks for your letter of January 25 in reply to my letter of January 22 and which farther amplified your memorandum of Jamary 19, 1951. X have had opportunity to discuss the natter of utilising alualmea powder (which as you know consists of a mixture of metallic aluminum and its oxide alumina) in the prophylaxis of dlatoa&eeous earth pneumoconiosis with Dr. Anderson of Lompoc, Mr. Klsenbast at Johns-M&nville, Mr. Tellefsen of Great Lakes Carbon Corporation, Mr, Bollearl, manager of Dlcalite Division, Great Lakes Carbon Corporation, and Dr. Dudley Irwin who recently spent a few days in Los Angeles. Z believe everyone conversant with the subject is agreed that there has been no clinical or ejqserlnental evidence to show that the inhalation of aluminum powder in and by itself has proven harmful to either experimental animals or human beings. A perusal of the literature would indicate that insofar as animals arc concerned, the use of aluminum does seem to alter favorably the course of quarts silicosis under the conditions of the experiments. However, there appears to be considerable disagreement among qualified investigators as to how much effect aluminum has in preventing or altering the course of quart* silicosis in human beings. Some feel that suoh effect if any is due to the associated dust control and/or to psychological factors. It is possible that not enough time has elapsed to accurately and properly evaluate the effect of aluminum inhalation in the treatment or prevention of silicosis in human beings. I personally am opposed to using aluminum inhalations among diatomaceous earth workers at the present time. It is ay belief that before we undertake its use in human beings we should at least complete enough animal e^erdmeats MTC 013887 Dr. A. I. Lanza March 1, 1951 to be able to state that the ubs of aluminum dust along with flax-calcined diatomaceous earth does not enhance or aggravate the disease as produced experimentally in control animals dusted with the flux-c&lpined material alone. I make this suggestion for the following reasons! 1. It is an established principal in the practice of medicine that before any medicinal agent or combination of agents is used in the treatment of frnm*o beings we shall have tried the agent on animals for the purpose of demonstrating, {1} its haxmlsssness, and (2) its potential therapeutic properties. It Is one thing to say that aluminum inhalation given concomitantly with the inhalation of quarts dust is hamless to human beings, and quite another thing to say that the use of aluminum dust along with the inhalation of diatomaceous earth products will be hamless to workers in the D.E. industry. Tor years everyone connected with the D.E. industry (executives, chemists, clinicians, lawyers, pathologists like Drs. Gardner, Vorvald dames, consultants like you. Chick Sander and myself) have stoutly maintained that diatomaceous earth pneumoconiosis was quite different from silicosis. Aren't we being somewhat inconsistent by inferring that because aluminum may prevent quarts eilloosis it will also have the same effect when used with D.E.? Surely ws would be on safer ground after having some *<** experiments justifying clinical trial of this treatment. Vc must recognise that every so often a diatomaceous earth worker develops a disabling and rapidly progressive nod occasionally fatal case of massive conglomerate fibrosis from the inhalation of diatamaeeous earth dost after a comparatively short exposure. I have had the doty of appearing on 1dm witness stand in connection with a number of eases which were adjudicated by the California Industrial Accident Commission. Many of the attorneys who represent the applicants in these eases arc capable of asking rather pertinent and penetrating questions* If such as attorney were to ask me on the witness stand - do you know of any experimental animal work which indicates that the simultaneous inhalation of aluminum dust and flux-ealoinad diatomaceous earth will give rise to no more serious pulmonary condition than the Inhalation of the D.E. dust alone? - I should have to say, *Bo,* In other words, I would have to admit that we have not gone to the trouble of trying out the combina tion of dusts on animals, this could be a very embarrassing situation and an unscrupulous attorney might easily maintain that the combination of the two dusts is capable of giving rise to a more serious type of pulmonary disability than would be expected if the D.E. dust were inhaled alone. If the Industrial Accident Commission was inclined to believe this, it would put the employer in a very bad position aedioo-lsgally. He would have acquired a two-fold liability - both industrial injury and malpractice. Please be reminded that there are a number of qualified workers including Drs. Irwin, Torwald, Schepers, and myself who believe that Shaver's disease and the massive conglomerate fibrosis sometimes seen in D.E. pneumoconiosis are essentially the same condition. It is very possible that Shaver's disease is due to the inhalation of ultra-micro scopic particles of crystohalite and/or tridymite. e know that the fumes given off by the corundum furnaces contain MTC 013888 Dr. A. JT. Luisa March 1, 1951 ultrs-microscopio particles of silica and alumina, Inasmuch as the raw bauxite contains both alumina and quarts it is reasonable to assume that much of the quarts has bean converted into exystobelite and/or trldyaiie by the high temperature (2000 centigrade), Tern will remember that at the A.M.A. meeting is Chicago in 1948 Dr. Jephcott reported that studies with the electros microscope showed ultra-microsoopic particles of alumina in the fumes. He did not mention silica but it was reported at the Saranac Conference oa bauxite in 1947* It has been asked more than once * why if alumina is capable of preventing pneumoconiosis due to any fom of SiOg * amorphous, quarts, crystobelite and tridyaite, why does it not prevent Shaver's disease? the work of Drs. Shaver and Riddel would indicate that Sharer* s disease can be more acute and rapidly progressive than our worst eases of diatomaceoua earth pneumoconiosis. A sharp attorney could easily emphasise the point that we should have known from the experience with Paver's disease that alumina or aluminum oxide could not prevent dlatom&eeous earth pneumoconiosis bat might actually enhance or aggravate it* How It familiar with the eaplanation given by Dr. Irwin as to why the alumina present in the fumes of the bauxite furnaces does not prevent Shaver's disease but so far as I know. Dr. Irwin' s explanation is entirely a theoretical one and has not been corro borated by scientific experimsats vith animals. I am very enthusiastic about some qualified laboratory undertaking experiments with aluminum in combination With flsue-ealclned D.E. It should be possible to get an answer from such a study in the matter of six months. In view of the above consideration* I think that we should withhold the use of aluminum in humans until the conclusion of such animal experiments. Please let me know your slews. Sincerely you: / Reginald H RHSife 0.0. Mr. Tellefsen - Great Lakes Carbon Mr. Bollaert - Great Lakes Carbon Mr. Klsenbast - Johns-Manville Dr. Anderson - Johne-Manville Mr. Woodard - Johns-Manville Mr. Westmont - Johna-M&nville MTC 013889