Document YLwVk0YbEvn7qMw36e3xwMnO

FILE NAME Insurance Industry INS DATE 1957 July DOC INS014 DOCUMENT DESCRIPTION Published Conference Presentation Section of Insurance Negligence & Compensation Law - Trends in Industrial Lung Yesterday Today and Tomorrow SECTION OF INSURANCE NEGLIGENCE AND COMPENSATION LAW PROCEEDINGS NEW YORK NEW YORK JULY 8-15 1957 AND | London England July 25-26 1957 ee e OFFICERS He COMMITTEES 1957-1958 ROSTER NOTE articles and committee reports published herein are not to be deemed to represent the opinion or views of the American Bar Association or of its Section of Insurance Negligence and Compensation Law unless and until adopted pursuant to the laws of theAssociation and the Section AMERICAN BAR CENTER * - CHICAGO 37 ILLINOIS SPONSORED BY COMMITTEE ON WORKMEN'S COMPENSATION AND EMPLOYERS LIABILITY INSURANCE LAW TRENDS IN INDUSTRIAL LUNG DISEASE TODAY AND TOMORROW YESTERDAY By JOHN P. WYATT M.D. St. Louis Missouri The inhalation of vapors smokes and dust with producing potentialities has been of deep concern to man over many generations The potter turneth the wheel and cleaneth his furnace are Biblical references to the early beginnings of industries with potential siliceous hazards Mark Ruffer studying exhumed Egyptian mummies of the XIII dynasty referred to the injurious marks left by silica in lymph nodes draining the lungs One of the finest historical medical reports is by Georgius Agricola in his De Re Metallica which was written in the sixteenth century The English translation was made in 1912 by Herbert Hoover mining engineer at that time This translation was made some 45 years before the advent of modern Republicanism TERMINOLOGY Before launching into this review of occupational lung diseases due to dusts or chemicals a word on terminology The term pneumoconiosis is employed much as Leroy Gardner used it meaning in essence all chronic lung changes directly attributable to the inhalation of dusts and chemicals The label pneumoconiosis is a specific term not a disease entity From the standpoint of clarity in the interests of both legal and medical pro- fessions the specific type of an occupational lung disease should be speiled .. _- out If for instance it has been clearly demonstrated that a certain coal dust is responsible for a characteristic lung condition it should be so recorded e.g. Pneumoconiosis in Anthracite Coal Loaders Northern Missouri Coal Fields Mine ... " The creation of hybrid names or exotic terms for occupational dust dis- . -eases deplored as the terms introduced are often without signifi~~ - cance or as Merewether says about ptilosis a lung disorder allegedly due to the inhalation of ostrich feathers What this definition really means ~ a only the bird knows EARLY DAYS OF SILICOSIS A. J. Cronin writing in The Citadel with the scene cast in the 1920's = had this to say on the paucity of knowledge of dusty lung and its ultimate sequelae There was evidence mostly conflicting from South Af ca upon that red rag inhalation 4% of Rand Labour troubles gold miners phthisis which w dust . . . but beyond that nothing if undoubtedly due to * Professoorf Pathology St. Louis University School of - 192 The the pa numbe concen betwee Fever du ar With the 20 Africa and N bercul no do the s rich 0 nature tion of Gaule Fre to the such : no lor of exp stated was 8 was 2 in nu parts these M COSIS cases tion cardio in fo appe The \ hype hype today the li either was | disab Th incid INSATION AND ? ESTERDAY producing po- nerations The iblical references hazards Mark dynasty referred ining the lungs < Agricola in his ry The English engineer at that : the advent of 7 iseases due to neumoconiosis is ence all chronic is and chemicals ase entity From nd medical pro- should be spelled at a certain coal it should be so aders Northern national dust dis- without signifi- der allegedly due ion really means ast in the 1920's and its ultimate \ upon that red rag undoubtedly due to - cine om JOHN P. WYATT M.D. 193 The fundamental lesion in silicosis is familiar to all who have studied the pathology of the lung It has a consistent pattern which holds for a number of different mining areas in which there has been exposure to high concentrations of free silica The dust hazard responsible for this pattern between the years 1890-1935 was very great Nesbitt in his book Gold Fever writing of the years 1912-1915 said Men worked out their eight years or a little more and duly died dutifully conforming to a strange custom of an underground country ance company would do buiness with a miner as though No insur- With the disintegration of tin ore mining in England at the beginning of the 20th century these disbanded workers sought employment in the South African gold fields and in the diverse mining areas of the United States and Mexico They brought with them poor mining habits dormant tuberculosis and nomadism the miner's prerogative These three features no doubt played a prominent role between 1900 and 1935 in spreading the scourge of the mine in this country and in other countries in which rich ore areas were being ripped apart A highlight on the destructive nature of silicosis is recalled on considering the rapid onset and dissemina- tion of silicosis and tuberculosis as observed in construction workers on the Gauley Bridge project in West Virginia THE CHANGINg Tale of Silicosis From my own observations and from leading investigators contributing to the medical literature it seems probable that severe degrees of silicosis such as were described in the first 30 years of the 20th century are now no longer produced Not only has the severity decreased but the length of exposure needed before silicosis develops has greatly increased Smith stated that in 1916 the average underground service of the new silicotic was 8 years During the 6 years immediately prior to 1947 the average was 20 to 21 years The most striking feature is that the nodules are fewer in number localized and practically confined to the upper and posterior parts of the lungs The disease as it were does not now invade beyond these strongholds My earlier experience with silicosis was derived from investigating sili- cosis in gold miners working in northern Ontario gold fields In cs oo mp ml eic 5a 0- analyzed was concomitant cases over years ago tuberculosis tion in over half of them and death in another 20 per cent was due to cardiovascular difficulties Most of the cases observed recently have been in- foundry workers In these workers the complication of tuberculosis appears to be reduced and confluence of the silicotic nodules is uncommon The workers die from other conditions such as Bright's disease malignant hypertension or malignant growths unrelated to the lung The problem today is to assess the degree of disability and determine if possible that the limited degree of micronodular silicosis produced pulmonary disability either through fibrosis or adaptive bronchovascular changes or that death was hastened The large lung section is of inestimable value in correlating disability with structural alterations and anatomic extent This lessened severity of silica pneumoconiosis and curtoaf ciurltaeilded incidence are attributable to excellent housekeeping in the majority of manu- | : t | MELMEL -- : MEL 2 a . Faas e ores 22 194 TRENDS IN INDUSTRIAL LUNG DISEASE facturing plants careful tracing of tuberculous carriers and thirdly with the knowledge that widows now control 70 per cent of the wealth in the country there is no need on their part to marry again infecting their second and third husbands with tuberculosis This was the common story 50 to 100 years ago There are two other facets of silica pneumoconiosis which might be touched on one is the differing susceptibility of individuals in developing silicosis and the other is the possibility of eliminating silicosis completely as an occupational hazard in siliceous industries Some years ago Riddell worked out the following time table on the incidence of silicosis in certain occupations Gold mining Foundry Porcelain 24 men working 10 years 228 men working 10 years 933 men working 10 years 1 develops silicosis 1 develops silicosis 1 develops silicosis The differing incidence of silicosis in the different industrial areas can be ty. explained by the varying concentrations of dust But the interesting aspect ~ which is worthy of future investigation is that many men escape the crippling fr disease yet apparently working under similar conditions as the individual ty 2 ro afflicted with silicosis As to the second aspect in modern plants probably dust suppressive measures are as effective as it is possible to make them A preventive or ran < i -. therapeutic feature directed against the development of silicosis but which needs further research is the possibility of introducing an antidotal com- ponent into the lung to prevent the pernicious particles of silica from going into solution and causing aggressive nodular scars within the lung This in essence is the most satisfactory explanation for silicosis nr . : 5 a antidotal neutralization of this action may lead to the eradication of the disease and its disappearance from the roles of workmen's compensation acts On this point it has been commented on in medical circles that a paradoxical relationship exists between incidence of disease and litigious interest The current position of silicosis is an illustration of this expression ne The question of slowly developing complications following upon remote , exposures to noxious agents or pernicious dusts represents one of the plagues . which afflict the medical and legal professions It is one that requires care- 2 ful analysis with the expenditure of every effort to reconstruct the chain - 7-4-7 ~ -- events before precipitate legal decision is appendeAdn alleged -~__ relationship between lung cancer and silica pneumoconiosis has been put forward On this it should be remembered that the incidence of lung ... ~ cancer is quite high in the general populaa ndtuni reloatn ed to the siliceous . | industries A recent survey of 1438 cases of silicosis showed an incidence - =. ~~ of 0.70 per cent lung cancer and in 1393 underground population cases there was an incidence of 0.93 per cent Only in hematite miners in which there is a heavy admixture of iron with silica has there been any evidence adduced for an increment in lung cancer et : Years 1932-1947 1948-1955 . oe ~ : - . Lung Cancer % 4.5 15.4 : an . The fre reported : several fa these part COAL A. Witho Witho in the The ye coal was disorder by black early atte was a sir interstitial The ye a leader i not no dane danger stat danger The ye mins and due to a these find through s Pennsylva basis of ra silicosis centage c tributed t Pennsylva fibrosing fibrosing still seem loading st coniosis th lead to a investigato lishing the now coal the medic In the are a few terms an f and the . nized it a genuine ~ y with in the 2 their story JOHN P. WYATT M.D. 195 The frequency of lung cancer in male miners hematite area was reported as 2.0 per cent This recent study by J. S. Faulds indicates that several factors may be operating in the development of lung cancer under these particular circumstances ght be loping pletely iddell certain Coal Workers PneumocONIOSIS Twin of Silicosis A. J. Cronin 1937 in The Citadel says Without jumping to any immediate conclusion . . . the incidence of pulmonary trouble amongst the anthracite workers was positively in excess of that existing in the other underground workers in the coal mines The years 1800 to 1875 were those of indecision as far as the role of licosis coal was concerned in the production of a genuine occupational lung ilicosis disorder As early as 1834 the scourge of the mine was accompanied licosis by black spit and autopsies showed a soft black lung Despite these can be aspect ppling vidual early attempts to grapple with the problem it was not clear whether there was a single pathological entity or a group of entites e.g. bronchitis interstitial pneumonia asthma etc. The years 1875-1940 were those of innocence Mavrogordato long a leader in the investigation of the dusty trades wrote in 1922 that Colliers ressive tive or do not now develop miners lung diseases and a great investigator Haldane stated that The dust the miners breathe protects them from serious 1 fo 4- silica in the licosis of the isation Is that tigious ession Remote lagues "care- chain - danger The years 1940-1957 have been crucial years of examination Cummins and Sladden had considered the shortness of breath in miners to be due to a form of silicosis modified by the accumulation of coal dust yet these findings were in miners who had done no hard heading drilling through siliceous rock At the same time the anthracite coal fields of Pennsylvania were surveyed and the lung shadows of the miners on the basis of radiographic studies were graded as I II or III degrees of anthracosilicosis Although it had been noted that in these miners lungs the percentage content of free silica was low the radiological changes were attributed to the long exposure of dustier systems of mining producing a high total storage of silica The conclusion of this report from the anthracite Pennsylvania fields was hedged by the remark that Silica is usually the fibrosing agent although adherence to the general term pneumoconiosis still seems desirable Then Gough uncovered 1940 that laborers alleged loading steamships with bituminous coal developed a distinctive pneumo- en put ' f lung coniosis that was directly attributable to the action of coal not silica This lead to a complete of the South Wales coal field by a number of liceous investigators e.g. Fletcher Gilson Heppleston and others idence _ lishing that coal dust itself can produce pulmonary fibrosis In England alation niners now coal miners pneumoconiosiiss an accepted entity recognized by both the medical and legal professions ee on any In the United States the extent of this disease is not known but there es are a few scattered reports that indicate its existence cloaked under the terms anthracosis or miner asthma Although the controversial aspects and the factors which hinder the investigation of this condition are recog- nized it was felt that effort to label coal workers pneumoconiosis - a genuine disease entity was warranted = - . - 4 | 196 TRENDS IN INDUSTRIAL LUNG DISEASE It is customary in textbooks and other writings to quote silica as a hazardous dust and to regard coal as a harmless dust But Gough says In our experience the dust of commercial coal is harmful when breathed in the quantities in which miners and other coal workers in Wales have been exposed during the last 30 years In coal workers there appears to be three distinct forms of pneumoconiosis involving three different pathological processes First there is the relatively uncommon classical silicosis seen in men engaged wholly or mainly in drilling or hewing rock and cutting through strata which separate the coal seams Hard heading is the name given to this occupation On the other hand there are two distinctive phases of coal workers pneumoconiosis First there is the called benign pneumoconiosis as referred to by most writers in which foci of coal dust occur throughout the lung and in relation to these focal emphysema develops The pathological implication is that the emphysema is mechanically produced by the deposition of coal dust The other phase is a late developmental one of massive fibrosis superimposed on simple pneumoconiosis These massive lesions appear to be the result of infection developing in a laden lung and the infection appears to be tuberculosis This third form is called infective massive pneumoconiosis In this third type of infective massive pneumoconiosis because of the great amount of fibrous tissue the progress of the disease is slow and death usually results from congestive heart failure This is directly attributable to the encroachment of the fibrous tissue upon the pulmonary vessels which increases greatly the effort required of the right heart eventually ending in failure The rank of coal appears to influence the disease process Extrapolating from the evidence put forward by the South Wales investigation one would anticipate that the anthracite coal fields of Pennsylvania would produce a higher incidence of coal miners pneumoconiosis than the bituminous fields of Utah To determine the true cause of death of coal miners dying in their fifties and sixties requires a post mortem examination with detailed quantitative studies of the heart alterations It is only by such studies that the true nature of the shadows in the chest can be determined Shadows in the chest in the coal worker do not necessarily mean an occupational disease Far too frequently such an indiscriminate diagnosis leads to unnecessary entanglements raises false hopeosf compensability and burdens the - administration of management On dusts akin to coal in that they too were previously regarded as _ innocuous it is conceivable that inhalatiofn iron in insulting quantities over many years or barium or graphite or carbon black could produce a disabling lung disorder But such cases have to be carefully evaluated as certain elements because of their high atomic number as iron and barium are opaque to rays and produce shadowings of the chest fields This of itself does not mean disability . yy - whe SILICATE PNEUMOCONIOSES Lie _ Most silicates in the natural state are not responsible for fibrotic contrac- tures of the lung although in the packingand shipping sectionosf industrial ae ae plants conce atmosphere Engineer's and color to clay for the ducing irre a Non With di tensively m problem m as a filter fo The crude exists as ar over some diatomaceo With cal soda to 180 are produc powers tha personally cellular inc earth and induced alt Between of diatoma was concer rate of indi advent of r nature of t industry intensity of ing away be anticip bronchova compromi } monary he b Fibro ~ Asbesto crucible fc ingredient have long nized by th ucts such refractory ~ The mi association - of the vein JOHN P. WYATT M.D. 197 lica as a says breathed in e been ex- oconiosis plants concerned with the commercial preparations of such substances the atmospheres are frequently dusty Sherlock Holmes in the Case of the Engineer's Thumb says that Fuller's earth is a valuable product as a filter and color removal agent sillimanite in porcelain manufacturing and China clay for the pottery and ceramic industries All can be given as far as producing irreversible lung changes a clean bill of health relatively mainly in 2 the coal the other .coniosis red to by ng and in mplication on of coal a Fibrous Pneumoconioses With diatomaceous earth widely used in the United States and extensively mined sacked graded and treated in southern California the problem may be somewhat different Diatomaceous earth has many uses as a filter for dynamite abrasives polishes extenders and building materials The crude native diatomaceous earth salt water type from California exists as amorphous hydrated silica opal Daily inhalation of this dust over some years may produce diffuse linear lung shadows Fresh water e fibrosis diatomaceous earth does not appear to have this stimulatory property ns appear infection With calcination heating to 1800 or flux calcination heating with soda to 1800 of the diatomaceous earth large percentages of cristobalite 2 massive ise of the and death it able are produced This latter produced constituent has greater fibrogenic powers than its natural occurring kin quartz In the cases which I have personally observed one can recognize two basic reactions a marked cellular increase along the bronchovascular pathways due to the native earth and secondly an equally distinctive nodular response due to man- a hich induced alterations in the diatomaceous earth entually e process Between the years 1930-1940 the complications observed in the workers of diatomaceous earth might well at least as far as the California field investigainsylvania s than the was concerned have been attributable to the adventitial factor of a high rate of indigenous tuberculosis within its workers Since that time with the advent of modern methods of dust control and after a second look at the heir fifties antitative at the true ows in the al disease nature of the dust the working environment has improved greatly in this industry Because of this marked improvement in plant conditions the intensity of exposure to such dusts has been sharply reduced With the falling away of tuberculosis as a major disease the complications that might be anticipated because of the anatomical placement of the dust along bronchovascular channels are bronchial obstruction with emphysema and inecessary compromisation of the pulmonary vessels with the late sequelae of pul- Ardens the -- -- - monary failure Sil enemies garded as b Fibrous Pneumoconioses me quantities __. unparale of l unpl arae leld led properties was used long ago as a i d produce crucible for burning tapers before Vestal Virgins and was an important ne aluated as -7~ ingredient in the funeral robes of kings Both these professional trappings e nd barium have long since disappeared but the same unconsumable properties recog- ane This of nized by the ancients are now utilized in insulation and fire resistant prod- e ucts such as roofing materials theater curtains elements and a en I~ contrac- f industrial refractory products The mineral is mined out of limestone crystalline or artz schists in geogphical association with iron and alkaline earths The chief locations of the veins are southern Quebec southern Rhodesia Nework Nework Nework Californi~ ne 6 oN =~ we : OmMIAnr te 2 2 exe eo soe - D _ Sonn - 198 TRENDS IN INDUSTRIAL LUNG DISEASE Arizona Georgia Brazil and Russia Russian asbestos is usually of the harsh variety this is a mineralogical term From the physical properties listed below it is readily apparent why certain forms of asbestos are more frequently chosen for commercial prod- ucts e.g. white Canadian chrysolite because of its long flexible fiber is highly desirable for fabrication purposes These same physical factors are also responsible for the development and severity of the lung disorder The seco exposures to hygienic pla monary art heart failure Asbestos Types Amosite Anthophylite Chrysolite Crocidolite Tremolite Actinolite Tensile Strength 90,000 4,000 100,000 300,000 8,000 1,000 Spinna- bility ++ + ++++ +++ 0 0 Surface Area 220,000 . Heat Resistance ++++ ++++ ++++ ++++ ++ ++++ Fibre Diameter .0000008 In the ha of workers labeled ast to be due to sugar cane of Malabar Dock wo maining aft sudden sho Comparison Purposes plate Owir Carbon Steel 150,000 are rare Cotton Fibre Glass Fibre 75,000 . 150,000 . Loe .0004 .00026 cept is that this enigm Human Hair . ; . .0016 factory fe Nylon . + 3,100 .0003 allied disea tories may At the mine head and rock crushing houses the lung hazard is less frequently encountered than in the carding and spinning factories the site of fabrication for finished products although even here the incidence is low sema and F From 1900 till 1924 working conditions in some fabrication plants were to say the least unsatisfactory The dust was so thick that the hand could not be seen in front of the face Since that time conditions have been vastly improved through rigidly enforced plant hygiene methods The best of evidence indicates that with inhalation the silicate fiber of asbestos is trapped in the terminal bronchial ducts in the bases of the lungs and acting as a foreign body which elicits an inflammatory and subsequently an incarcerating scar reaction This reactive fibrosis and the asbestos bodies present a highly characteristic appearance under the microscope In the ray of the chest all that is seen in granular shadowing in the bases of lungs two complications of asbestosis frequently seen years ago were bacterial tuberculosis 7 pneumonias and engrafted on the prepared soil In manufacturing areas in England it has been held that 30 per cent of individuals in the early years of the asbestos hazard developed tuberculosis _:- either due to implantation of the tubercle bacillus upon the asbestotic => pneumoconiosis or a lighting up of a dormant childhood infection Since 1950 of the workers who were exposed in the dusty glorious = 20's one late ^/lterationwithin the lung which has been commented on by 3 investigators such as Perry Middleton and O'Donnell has been the de- - ~ - A recent a vegetable fields of a v portion of pathologica the defense the establis logical both pla tiss logical symptomat symptomat symptomat symptomat than should should the not Berylliu Berylliu In 1931 the consum about thro velopment of primary lung cancer This sequential development pattern ~ would appear judging from individual case reports to be an interesting + one Several investigators claim that 15 per cent of individuals suffering extremely became the television t _ from asbestos pneumoconiosis develop primary lung cancer ot atomic ene 7 JOHN P. WYATT M.D. 199 he The second possible complication in these individuals who have had exposures to asbestos of thirty years or more even in controlled reasonably hygienic plants appears to be the development of thickening of the pul- d- monary arteries leading to pulmonary hypertension and terminal right heart failure re VEGETABLE PNEUMOCONIOSIS In the handling of agricultural products directly or indirectly thousands of workers are involved Respiratory tract symptoms and signs loosely , labeled asthma bronchitis and unresolved pneumonias are often alleged to be due to the inhalation of such materials as hay grain tobacco pepper 08 sugar cane chaff cotton and corn products Louis Bromfield in his story of Malabar Farm gives an excellent clinical description of farmers lung Dock workers and shredders of dried Louisiana bagasse stalkings re- maining after the sugar juice has been extracted sometimes developed sudden shortness of breath blood tinged sputum and shadows in the ray plate Owing to the limited nature of the disease pathological studies are rare No definite incitant has been uncovered but the prevailing con- cept is that fungal contaminants in the drying bagasse are responsible for this enigmatic pneumonia Silo disease and Monday morning or factory fever encountered in the cotton spinning factories may be an allied disease state This pulmonary condition encountered in cotton fac- tories may have an allergic background with the termination being emphy- sema and pulmonary heart disease of CLINICAL MANIFESTATIONS re A recent case which was studied illustrates the difficulty of incriminating ald a vegetable fiber as being responsible for minute opacities in the lung cen fields of a worker in a weaving factory Fibers derived from the fibrous portion of the vegetable were inhaled over a period of 23 years with the of pathological findings being suggestive of a long standing struggle between ngs the defenses of the body and allergenic vegetable products To validate ntly the establishment of a genuine occupational disease required an analysis soer y and lies of both plants vegetable and industrial the effects of the dust upon bio- the logical tissues and the establishment of a probable relationship between of symptomatology pathological findings This is the approach rather go than the hasty allegation uninformed hypothetical question Awards cory oil should not be made on surmise or speculation Sietpgar ..7 METALLIC PNEUMONITIDES = _ .ous i by de- ern ting ring Beryllium of In 1931 only 2 tons beryllium ore were used in the U.S.A in 1946 the consumption had increased to 2,000 tons Much of this increase came about through heavy demands during World War II for an alloy with an extremely high melting point lightness and great elasticity Beryllium became the glamor child of metallurgy and has found wide usage in radiotelevision precisions tools incandescent and fluorescent lamps and atomic energy products - -. . ~~, Bo ~ 6 tet - ofa , a 200 TRENDS IN INDUSTRIAL LUNG DISEASE forms proceses lung disease develop diseases of the eyes skin and lungs Two lung disease exist an acute chemical lungs pneumonitis and the chronic granulomatous form The chronic pulmonary disease first showed up as a baffling lung condi- tion in the closing years of the war being first described in Massachusetts as Salem sarcoid This type of granulomatous tissue response is now considered by some investigators as a sensitized tissue response with beryllium being the sensitizing agent The minute amounts of beryllium recovered from lungs chemically analyzed would support the belief that sensitization through a previous exposure may play a prominent role in the development of the lung alterations I need only repeat that a worker overhearing the buzzing of a fluorescent lamp does not constitute an exposure The sharp curtailment of the amount of beryllium incorporated into alloys and its abolition as a coating for fluorescent tubings are two public health measures introduced which have effectively suppressed the develop- ment of new cases a triumph accomplished in a few short years through the cooperation of manufacturers insurance carriers medical professions chemical engineering and public health authorities Aluminum Shortly after the finish of World War II a distinctive form of a crippling lung disorder appeared in furnace operators and crane men working above bauxite fumes Bauxite is a highly essential ingredient needed in the manufacturing of abrasives From my observations on some 10 cases of this unique scarring of the lung the high concentrations of amorphous aluminum oxide apparently selectively damaged the air sac walls This diffuse scarring profoundly interfered with the vital exchange of gases in the lungs with the workers dying of pulmonary insufficiency No increased incidence of tuberculosis or lung cancer has been observed in this lung disease The diffuse scarring within the lungs comprised the small bronchi and the small vessels of the lung with the workers developing emphysematous air sacs which often ruptured precipitating acute massive collapse of the lungs or death resulted from congestive heart failure To the best of my knowledge this condition has virtually disappeared An understanding of these two conditions offers a framework for in- appeared already - vestigating other patterns of lung disease which have or on the medico horizon Cadmium nickel chromate mmaanygaanpepseearand many other valuable metals being used either in their elemestn atetba ondl ed or incorporated into carriers produce or may pro- a is meta metl al fume fever or a progressive scarring of lung unfortunate that scarring a healing process for infections produces a crippling vascular disease in the earth worker A late pathologic of the worker to these enzyme inhibiting psousbssitbailnicteys fios lilnodwuicntgioenxpoorsuprreomotion of a new growth in the lung With the rapid expansion of industrial it is from this latter group of chemi- might expected cals that development of future ocupational ocupational lung disease be as The fast moving chemical technologic developments reflected in = ~~ modern pro medicine U development stood Freq before the ev yet been offe lems will onl A word of Far too ofter fession unre occupational industrial lur tainable trut uncertain an of disease cl exemplified { orders cover in the future This word the individua tation failur to test the F alleged expo can only lea which may i genuine but miner In the futi be present dusts New due to the i innocent s All this will breath in pa of a union As path 4 that every c an occupatio needle biops breaking the changes in th ' a wrong or To parapl lung is a do occupational breathed du * . industrial hi its either in the es of the eyes cute chemical ing lung condi- 1 Massachusetts esponse is now nse with berylf beryllium re- the belief that nent role in the that a worker * constitute an .orporated into are two public ed the developyears through cal professions n of a crippling working above ed in the manu- O cases of this hous aluminum diffuse scarring the lungs with ed incidence of g disease The i and the small matous air sacs of the lungs my knowledge mework for inared already or ckel chromate either in their ice or may pro- the lung It is ns produces a . late pathologic zyme inhibiting the lung With grin of chemi- E expected nts reflected in == ==. -- _ JOHN P. WYATT M.D. 201 modern production processes means associated problems for industrial medicine Unfortunately too often industrial medicine has to await the development of a destructive event before the pattern of disease is understood Frequently the legal profession expects informed answers even before the event has occurred A solution to this general dilemma has not yet been offered The understanding and settlement of these potential problems will only come through careful investigation not hasty litigation A word of caution on the creation of new and modern pneumoconioses Far too often exuberance and enthusiasm on the part of the medical profession unrestrained have hinted at or directly led to the establishment of occupational lung diseases harsher words an attempt to establish an industrial lung disorder without evidence Russell has recorded that ascertainable truth under the best of circumstances in piecemeal fragmentary uncertain and difficult to glean Progress and understanding of all forms of disease closely parallel this philosophic conclusion This is particularly exemplified by the halting advances manifested by the industrial lung disorders covered this afternoon The valid establishment of pneumoconioses in the future will be no different This word of caution is directed to all groups concerned in the health of the individual worker Clinical coloring woven into a chest ray interpretation failure of industrial commissions or workmen's compensation boards to test the probity of the expert's evidence a facile correlation between alleged exposure and simulated disability these are all false salients which can only lead to the unjustified creation of a spectral lung disorder .. . which may return to haunt its creator Coal miners emphysema may be genuine but it is equally true that genuine emphysema exists in the coal miner CONCLUSION In the future not only will the conventional patterns of pneumoconioses be present but there will be modifications through admixture of other dusts New lung hazards will alter the industrial lung panorama perhaps due to the inhalation of newly discovered volatile materials rare earths ' ~ innocent silicates exotic plant matenr ewli y cra eatl ed plasor tpliasctiscs All this will substantiate the quotation In this harsh world draw thy breath in pain This utterance is from Shakespeare not from the tongue - of a union steward As a pathologist I would make a plea to both claimant and defendant that every channel be explored in the investigation of a potential case of an occupational disease by correlative pulmonary function studies and needle biopsy of the lung or the autopsy mortui vivos docent or even breaking the strange isolation of death with an exhumative study The ' changes in the lung may be the last clear chance to obtain justice redress a wrong or write new law To paraphrase an earlier reference of Thomas Belt writing in 1942 The lung is a dossier filled with incriminating evidence In a very real setise an occupational log book it holds an indelible record of mineral particles breathed during life and death.constitutes of palimpsest the industrial history The lung of the worker in dusty trades is a parchment & 202 TRENDS IN INDUSTRIAL LUNG DISEASE a fabric often inscribed over from top to bottom As for the inks they may | be the black dust of coal the glittering tracery of silica or the red of tubercle I trust that this recapitulation of the fumblings in the past on dusty lung disorders present ho tancies and possible future trends will not remind too many of this audience of Hernik Ibsen's writing in Peer Gynt This is a tale turned turvy prinked and tinselled out decked in plumage new and fine till none knows its lean old carcass That is just what you've been doing vamping up things wild and grand . . . and with all the other horrors filling me with speechless dread till at last I recognized not what of old I'd heard and known tes aes FV AA CSN Fre se ota ' ; + ADDRES THE SYST Supervisi States is a contrivance fundamenta of the publi The law objective is lands An for the cou The legal c at the outs tution and evitably inv Until the insurance \ company w to transact ence It is the authori volves inte exercisteh the wishes by its enac tion of re Whether a that the sy the United regulation It is the regulation * Commi United - 59 STAT