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FILE NAME: Metropolitan Life (ML) DATE: 1952 DOC#: ML076 DOCUMENT DESCRIPTION: Bulletin - Diamotaceous Earth Pneumoconiosis & CA Dept of Public Health Report - Several Cover Letters Attached 33"0*_* i a P 8 -I Ip 0 s *& y> :4 February 20, 1952 Dr. A. J . Danna, Chairman In stitu te o f In d u strie! Medicine Me Torte U n iversity - Bellevue Medicei 477 First Avenue MBe?......T. orte 16, N. Y. Center \\ Peer Dr. Leona 1 Ret Labeling of Asbestos Fibre f V At you ere aware, the In d u stria l Conjrisslon of I l l i n o i s he* promulgated rules es to the lab elin g o f substances harmful to the health tend sa fe ty o f employees. This i s the seme law Ttodiver Brown wrote you about on October 1, 1951 In connection with dintoneeeous earth , "Putt* Is s p e c ific a lly referred to end in tmr opinion asbestos fib re comes within the purview o f the re rulttiana. The I t r requires that the la b el contain a signal word, 'hie word is intended to draw atten tion to the presence 01 the Uettrd. and to in d icate the severity of i t . The signal words ere in order o f diminishing severity of hacardi (1) , DABQERj ) *VE!REIB0*J 3) ` CAUTIOK*. In naming the product one must nvold using e non-descript!ve code designation or tr*da name tnd should give notice o f exactly what hazard* ere present in connection with the customary or reasonably anticipated handling or use of the product. I t is our in ten tio n to la b e l our bags containing i.cbcttoj f ib r e , using the follow ing! "CAUTIOK - ASEBST09 FIBkE' "Inhalation of asbestos fibre over long periods may be harmful. The'' m aterial thould be so used es not to fcreate duct or, i f ' t h i s is not possib le,: employees should be equipped with adequate pro tective devices.1 Ke would g r e e tly appreciate your comments concerning the proposed la b e l and any suggestions you may have fo r improving the firm Iron the standpoint of accuracy or otherwise. Very truly yours, ai; f Arthur L. fis h , J r . Legal Department N O CO o> ^JJlistjoicl lJnclubiLa[ dtinia ^Uizztjoxcl <zA/[Lni, Qus.. February 21, 1952. Dr. Arthur J. Vorwald, Director of Research, The Trudeau Foundation, Saranac Lake, N.I., U.S.A. Re: Alphonse Labb vs Bell Asbestos Mines Ltd. Claim No: 75907 "Cancer and Asbestosis" Dear Dr. Vorwald, For your information, I am pleased to send you the following "confidential" report which as you may understand has no official character whatsoever. This case was heard before the full compensation Board during 3 full days, February 12, 13, and* 14, 1952; the BeUemare group had 2 pathologists, 1 epidemiologist, 2 clinicians chest men as experts and Mr. Sabourin had Dr. Lanza. The hearing was adjourned to March 11th, 1952. i ^ In summary, the pathologists have certified that the cancer in the case of was a pulmonary epithelioma anaplastic or oat cell carcihoma variety stating that it was impossible to ~an<*I ***** . .... . ! The other experts certified that the causal relationship between asbestos is and cancer of the lungs was probable and even certain. I am anxious to know what Mr. Sabourin will bring in March and I am also anxious to discuss this case with you at the first opportunity. Yours very truly, PC/JS t Paul Cartier, M.D c f '* - f/ Qy NEW YORJ^NTVERSITY-BELLEVUE ML iCAL CENTER or wr* r a u wtvtlctt POST-GRADUATE MEDICAL SCHOOL 477POUT AVINUI. NEV YOKX U. N.T. NOT^D HM8 to u tio N r or m u r u u . iumuni OKKm t-tioo Marcs }, 1952 Mr. A rthur **. f l a k , Jr. Lsfxl D apartaaat J o fiju -H a an ilr Corporation 22 st Oth S t r * a t 3av ^cxk 16, Saw fo r k 9h t Mr. ntki 1 u j u a t now l a r a e a ip t o f your l a t t e r o f Fabroary ^OthTl th in k tha wording th a t you propoaa f o r y ou r bug* 1 q u it * a cc a p ta h l* and adaqnataTj U a n a tte r o f f a c t , tha uaara o f tha varioua typo* o f product th a t eauaa Bounoaaalosla la th a lr productloa ar* ra ra ly S axposad to prolonged c e a c a a t n t lo a a t h a t a r* o a a a a a tla l i s producing dlaaatas o f tha lm g a . Sincerely y o u n , A .i* ' L a a u , M.2. yr**% v-c-j \r k S O M . M .b . k* r v A * ; <!>* April 2?, Iitf2 VI V< iv .4 *'*** ^<( ,( t , i K -55sSIai-t; <yK-UH4<U(U>/tU- nCt.> lir..Anti.any J. Lar.ua *t tew -- ..--->v Ub#..W w-toWkil ^ %lWii* *4* #A*# Corsora 22 East Fc.-tiofh Sire- Hcv/ i'or- 16, !Jew York Pear Dr, Lausa: " # * . # At Dr. Smart's request, I ara sending you. a cop/ of a monthly bulletin vhich has be-a routinely distributed by our Bureau of Adult Health. Au you can see, the subject cotter of this issue is not so routine. Distribution had'elreedy been partially r.ado before. this t/es called to the attention of the Division Office, and although wa have temporarily discontinued distribution, I think ns shall look less conspic uous if vie send out the rest. Had re seen the raft in this office, I think re vrould have postponed n discussion of this subject until sons future date. Certainly v;s vould have done sose editiarj hc/.ever, tho thins is done. ' . i l l L t u Sincerely yours,# FroJirSt vk Kricts, Assistant. Ch.iaT, Division of Preventive Hsdical Services KlKsdr *^T.S . ? 5 >!  Occupational Health Bulletin "H" DX/i70x;iCE0;f5 EAF.TH PE2H;I)5C:iICSI3 Diatoraccous earth i s a fern of "free siller./1 or silicon dioxide (SiO->).<* Like the ordinary.silica from quarts, diatonaceous earth, when inhaled in sufficient amounts over sufficient periods of tine, causes a disabling ar.d often fatal disease of the lungs. . . 1 In this country the disease is usually teraed "distomuceous earth pneumo coniosis."-* In Europe it is ordinarily referred to aj silicosis due to diatonacsous earth. The disease differs in certain characteristics from, and has certain basic similarities to, conventional silicosis. These will be discussed. . . . Vhat Is Diateraccous Earth? The natural or raw diatosaceous earth is a fina grained material composed of the siliceous skeletons of tiny aquatic plants known &s diatoms. Through the ages, these have been deposited on the battens of todies of fresh and salt water. In various part:*, of the world, tlicso uepaiits have appeared at the earth's cur- face and many of then arc no;: being cornorcially exploited. Kineralogically, diatoiuiceeus earth is classified as o:*al, a hydrous form of silica. The pure cinere1 is cntii*cly free silica (silicon dioxide ~ S.iC^), but ir. its nntxurel elsto din tcr:ar.eous earth contains about 25 to .'O.'i water. Ccr-.nrrial varieties variously coatsin cmiII .-.annuls cf impurities such as clay, lime, quarts, ar.d others, Practieally all samples of the dry earth, however, contain upward:; of 75f> silicon dioxide. The natural diatomaceous silica dilTors fro** quarts silica, the c.n.T.v.rm type found in .vest Mine::, in the fact that quart:: r.ilAca shews a characteristic e.r y ljp.e in ;;twi.u:; with 1- r.'.y s.; ::t,o:v.:l::r, :i.-..-ivas * ".'VC siJU:.;*1 in silicon dior.ide (.'HO4-,) I t '**:;in:;.Is j;a |ynv*. trrr f..* 'i: l . :;: ;... i .i . I JB -m .* c:**- iiv li:;i..r. **,,** f, * tir;; t'rcv ` ^ viU - - r c\:ih is i:.;\:-.Uy \.c., il errataLlinu pattern with wally arsii-olc e*ulp:v:::f. to show n definite Vr.cn the natural ciato*:?.;: -'.'.z earth is subjected to heating (calciriu;,) ;.n:l treel-.cr.i (i'.'.uidr.;,) with certain rheaicals (such as ::cJii:.c carona te) i;, _hc rar.ufactuvo of numerous corjicrciil products, a varying proportion c: the r.o-c*llt; tsarphous Totee is converted to a crystalline fora of silica known its crir.tobdi t?. In the United States, diatokaceous earth and its products arc known by a large -variety of r.r:2S, comercial and otherwise: dieted te, edite, ciicditc, etc., and there sre various designations for powders cent"ininixtures of iatoatccous earth and other dusts, such as siloed, etc. ' * In Europe, there arc also icany designations for the sar.e materials: 'infusorial earth, kicselguhr, fossil flour, fossil real, tripolitc, polirschiefcr, desnid earth, rudera, white peat, tellurirva, ranoanitc, bargaehl, etc. Uses of T)iatoracoous Earth Diatoraccous earth in one or another fora finds numerous practical applica tions: A few exacoles arc: a. Filtering and refluir? of sugar, syrups, spirits, juices, waters, petroleum. products, chemicals, varnishes, senses, pharmaceuticals, etc. b. Insulation of heat and cold in: power plant equipuent,* steel plants, . pctrolcun refineries, glass manufacturing, furnaces, kilns, refrigerators, etc. . c. Fillers: in battery boxes, roofing, flooring, waxes, paints, plastics, explosives, insecticides, abrasives, cosmetics, fertilizers, etc. d. Eulldin? industry: admixture for concrete, ccrents, plasters, hi-silica and puozoian ecacnts, roads, light freight building blocks, eta. c. Flr.cdlanoowr,: irmufacture of filter candles,' soluble silicates, glazes, oil-dccolorizing products, poultry litter, sweeping granules, etc. The percentage uses of dicteraito in the United States arc as fcO.lovs: Filtration 50> Insulation 25 Killers, r.iscsllar.cou5 2t>n * In 19A7, production in the United Slates reached 213,533 short toas and today the figure is doubtless cuch larger. (1) Occupt i."" ".! Tivlv.'tvi *\ V runva Ytix, /btl " 83 l`o*w.nliv.l occupational ivijosu'v.:; exist in the numerous industries which U.vJlise Ike Leriaj . ilow.rV*.: rv:;L :*-Ci: 0f dir.easc has boei in the irckistrir>:; or,gag-d in ".Vill!'IilV I1:a :;nterial :IV U s VV'iuCiS Ifni2o CJ*****..|:: of tkv inri.1 fl * j: i: iy jv.ris c ` h U:i t.M t--**< rant. x.r.H.v c(. terrriu) iy cxpV.i t~.i <: i :r.-. iii i.l:e V (''.1ilorn in, (hv,-. %**<>*I *.*1 ** , * nt # IW.rli*.'tion. 1 . L i : : ; j , S . D ., an d .v `e i'0 , V . li.s Ilill, 195^.. K e r r .' V i U i c i l i r - r U r . 2r.i c r t., licC raw - 2. C-m-urdcation froa Johns-tonville Corporation, Dec. 6, 1931* 3. podwyssoski, i/.: Tcitr. path. Mat., 2, 270, 1910, quoted in Vi*;liani,E.C., British J. Industr*. lied., jj, I4G, July 1943. /,. Lc^rje, It. T., 'no Rcscncrcntz, K.: Obsrr.T.ticr.s end Studies cn nil!rods bv 1)5r.toraccous Firth, /user. J. Public iicaith, 22, 11)55, Out. " * 1932. *5. Hue!*:, quoted in Nordnsun. ' . . 6. liorcnanr., Martin: Pic Sl-ublunri dcr Xi.c5elrv.hr Arbciter. Virchow Arch., 311. 116-US, 1943. , . . . 7. Duvoir, M., end Derobert, 1.: I>a Pn5u.~ec0r.i0se a-r terre de diatoreees rtude ttxoeriner.talc et clinicue. Ann. de nod. leg., 27, 48-58, Jen.-Feb. 1947. .' 3. Yiclicni, E. C., and Kottura, C.: Distsnaceous Earth Silicosis. Brit. J. Industr. Med., J5, 14S, July 1943. . . 9 .Cardner, L. U.: reaction of the Livir.i Pedv to Different Tra-s of Vjnral Pasts. A.I.M.E. Mining Technology, 2, 1-15, toy 1913^ Tech. ?ub. 929. '. * . * 10. Miller, J. If., and Sayers, R. H.: The Response cf Peritoneal Tissue to Industrial Dusts. Fublic Health Reports, 6, 264-272, Feb. 14, 1941 11. Johnstone, R. T.: Occupational Medicine r.r.d Industrial Hygiene. C. V. Monty Co., St. Louis, 1943, p. 3S3. 12. Examples of this say bs found ir. the following case records in the files of the California Industrial Accident Commission: LA 36-535 Hartnell LA 35-140 tobry LA 33-234 McLean LA 32-296 Hooper S? 35-723 Dilliazs 112-556 IfcCabo 13. Vorvald, A. J.: Pinton-.cnous firth Pr..-r.r?co:riosis, Pros. ninth Internet. Concrcr.s Ind. Med., Bristol, :ng., John Vright, 1949. 14. Death by D.istr Search, Calif. Tuberculosis And Health Assn., San Francisco, 15. Sir. Francisco Chronicle, Jan. 13, 1952. .. lu. lo 1, A\:.cv: l\n l;/ v arr. in Ih- Pv jorrutr. Yrr. Assn. C.uart-.u iy, March 1943 P ftjlftjC E D JM * 83 Ar.vr. In.inr.tr. i!y/,icr. J /. i.:>vr,iug, j. n.: C:!nrcr of T-tir r.rn Or-c m v.t.ion-.l Vr-n-.a, J. Anar. M*d. r--n P//Ii -45, y.:\.' iy/L 19 Gardner, L. . : Import to Johns-''w/iH e Corf.o--.tlon or. six lun-jr. examined, ioeluded in coon of Keeper wide/ vs. Industry, I.A 32-29o. 23* Motley, H. L.: Pr.tholnMrd rrd Plv-v1*r.ln^icnl Factors Trrolvr'J in th-? Trio tree i c:` Silicosis in Cn-.l Miner-,. Arch. Indus or. Jiy-ier.c and Occup. tel., 2, 305-373, Oct. 1530. 21. Erovn, . W., rr.d Van Uir.hlc, Ms *Prenant Stnt;:s of Alusir.ua in the . . Therapy cr.:l prorhrlaris of Silicosis, J. Ansr. Ked. Assr.., HO, 1024-io:$, July 23, 1949 22. Eaader, E. U-: Th* Alurir.ua lurr. "Ztschr,'f. Urfdlred. u, Eerufscrorl<h. 1949, June 3 and Sept. 15, 42. Abstract in Bulletin of Hygiene, 26. 265, March 1951. " . 23* Ivanova, M. G., and Ostrovskaya, I. s . Action of Alurinun Dust on Anind Organisa. .liy^icne and'Sanitation, iioscov, April 3, 1950. 24- Poitevin, E., Personal conaunicaticn, Kar. 4, 1952. 25* Anderson, V. H. : lapublish& tall: before Santa Barbara County Hospital staff Dec*. 14, 1950. *. . . 26. Anderson, V. H. : Diatcuacons Earth Pr.nr.v.occniosis. paper delivered at meeting of California Tuberculosis and Health Association, April 4, 1952, San Francisco. vJ co Ir. r.-l.'.'ir-i-., th*: J ? ! : : * . . . v i 11*: ; . . l ?.*. 1--r.:: i ' mi'! be ike prcaucvv r:* the crLJ-cer in i:\ the v i r l i , c:r-.iir.Iy - I'r.i*.:! r.:ut*:s. '.v.? ct.vrr ; Or:-.t '.z'.-.'j Ccr:-*" which ::r..*:~ a Mia:-. r-sr i'a llc ria , Leu Ar..; :U s. County, r.r.i i ; constructing a 2;:r;-*,,* -Lir.t rear L:<np-J'u. Yheri: arc othr small p:\v.ucvso ir. Sir.;a lirharc, Inyo and Sen L'ieto Coil",ti ca - # In.recognition of the potential danger to verkers handling diatcnacecus earth products, the leading producers have recently inaugurated a pro gran of labelling the containers of the powdered products as follows: Caution : * . 'Celite" materials consist of an almost pure caorphous diatcmaccous silica plus varying percentages of crystalline silica. Inhalation of silica clast over long periods nay be harmful. . * * She materials should be used so as not to create dust or-- if this is not possible-- employees should be equipped with adequate protective devices. (2) * * In the producing industries, there are numerous dust generating operations which have been incriminated as sources of disease. However, in California at leant, the chief danger scots teday are in the occupations having to do with sacking the materials, loading then into railroad cars, and in the baghouses.* In the diatazaceous-earth-using industries, sous of the trouble spots are those in which the materials are unloaded from railroad cars or other vehicles, or in which the material is emptied froa sacks ar.i mixed with other materials or other- vise used. . . Humber of Uorkcrs Deposed In the mining and milling industries of the four western-states, there are about 1,C00 employees (about COO in California) employed at ary one time. How- ' ever, the labor turn-over in the custy jets is exceedingly high, ranging up to almost 1Q0;> per year in certain instances, so that the number of workers exposed, whoso lungs nay have been damaged, is impossible to ascertain. The number of workers exposed to the dust in the numerous industries using these products is not ltnovn, but is probably very high. thf.m rr.>cr V U M . W . * His I.*>rv Is TUvwV.r.r.tln:, T-at Hot ifoed Often Knv:<*h Ipe:i Jn ;-GtD 83 In California . diatomsearn:, earth lies boon j:jl.^**7i *..ru* un.rveased for almost* W y ro.by.-:;o-.H (3) zr.y rap 'n 1;)U) r/r.irlr.v.ty in vhich he VMi iibl.i: to ft in r.nimil.* true gram:tozatous t.ii**bilW dual r.urr.ut'.'vvcius!j* ,!r.i.rod * ( M * the ~ "IV " i:; a Im*; toil', for n l ap. t. r.1J*:cLo- unit including fabric, log .!n ;l f.i 1b:v::, :.upp:* t i;; fa r th * la...;, a r . c u : ; \ v . 'vn, mvi rues r f rr.rcuri-.li:..: in a hat:.':: -r 1 t 7<\::: ir. 1 c*u tl.ry lagan ;vt! ; or,': published by . i*^'1w or. Firnan of Cr-rfy , J:**- ,-j> in 1Z-Ci. ;ie described seme LC3 I1l.st Lorn of Or:.r.-L- vko -re vi d in s of ciil mercurial poison 1M'il \1. ir --\Jr , *orri pgwwv ! l.rfore II: r.e>:4W%>WaMv ord iipaaarccl, quite a:; rhOC:-.a1t., as th .`lothlag vas done i-.bnu it, l 1912!, i ttl 37 e y a ea tte rs nt la ion ter , vas th eppaul "**1I1n*ar*a- i.J st the artl red ed icai by a .;cilu. report Than tl made by n le y organisation, the i.'atior.al Civic xeera tic it If the rcr.der will substitute the I.aggc and f-cor.srantz study for the Fre-oman study in ISoO and the California 7;is-rraulosis and Association fer the listionel Civic Federation, a similar picture bacca-js apparent. Dounin" (17) summarizes the problem -ell: "It is apparent in the study, control, and prevention of occupational health hazards....that the United States is net or. a par \rith other countries. Lack of recognition of the inportir.ee of industrial skin cancer stands out in sham contrast to the unrestricted and vide publicity given this important natter in Eiglaad, Germany, end Switzer land, vhsre these cancers are notifiable and compensable diseases, and infornaticn regarding then, therefor?;, is relatively reliable. The history of industrial r.oclicir.e here is full cf failures to prevent the unnecessary deaths in industry that have occurred, for example, from berylliosis of the skin and lung, cancer of the lung free chromates, * tumors of the bladder due to aniline yes, osteogenic turners iron radioactive chemicals, and cancer due to carcinogens in the ter indus try. All these industrial hazards could have been controlled or eliminated." _ Inc5dnr.cn and Prevalence of the Disease ho accurate data arc available because of (1) ignorance on the part cf most physicians of the existence of the disease; (2) the resemblance of the disease to pulmonary tuberculosis; (3) the failure to report the disease according to require cents of the California Labor Code.* (IS) Despite this situation, none figures at hand arc revealing. In the 1930 stu5y of Legge, of 1C3 c m examined, cl cr of.# had abnormal lung changes. Turnly years later, the Lompoc plant physician outrutted to the press his report that of 922 people he cicanined since 3/15, 33.# had lung changes. (If.) vi * 7ho iiarcau' s noixnl source of informatiur. on occupational disease ij^ im hm' reporting required by lav to tine California filet Department o f Indus tr ia l MoLt liv es. flection 6/,07 c.C tlir le lo r C;.!e stales: "every employer, insurer, r.nd i r i : n or ::u'V;w i ivn at tr.d.`. f.r.y injure.*, rnuyee rh::3.1 f i l e \nW\ the Division of Labor fit: Ms tics i.r..'. al.u.rarch, \c.`i.:r rules and rcgulallcns ]*r :.t r;i...d by the D ivlsir of Lr.Lir r.t ::: i a ce::.;)3i:ti; 7t:,:o:'t of every in ju ry to e v il uya'.* r.rl ii.t o." in Uu: cours:; of hi:: riploy.-nt c'.i s i b i !ity i\ : n.`; f vr. : injury rice:; not Jn:;L Mu-. }: i';.... t';y n r (V-.*s n..L ivquli- .a-rvveu o!.`i* r *.!.u ordinary f i r s t *.*1 I...nl..* *tr;i.* i o 51:, V-' V .`..1.roi::vi ovol.nc': (j** N*.' ** ' J.*'. i : . I * * *: L 1:* .*1 : 1; *.j r r !' / lir*.' >y c:j :f ii.*..l c::.. .. .1 *r:v:.;r. v:; of the- j'.-m'.u jlr 1 Accidaat Cor." L'-^ion ar. 1 c.i*.*.*:- tsntir.-.ur.:: : o v . L i o n is rc.-veulj.t:; iv,r.:- ciucs. (There rim muf. .r of i'iov .-a c .'is ; r iii s.it. rvsjcvis in the: la lu slrl Accident Commission f i l e s .) I'p I.o d>i.c of prc-yareiicr. of this h li-.-lir. ("mesh, ).v.'>2) th" Division of I/-t>r SLstislic:; ; r.J F.escuim-h i.sd cmc.-urnd for- yh..mic.\-.r..**. royorts of the disc-r.sc, r.ll cf them since January A thorough chick c: n il employers1 reports from. 19Ao to the end of 1951 by the Division reveals one re port, which ..os received in D-;corbcr 1951. r'or the relatively scall nunler of workers exposed at cry cr.e tine, the attack rets is high by any standard, ever. or. the cosis cf very incomplete deta. Tuberculosis statistics for Santa Barbara County for the area where the diatcmaceous earth industry is located are now being critically analysed. Beports in the lay press indicate they vere high. (15) Pathology of the Disease * VigliardL (S) describes the lungs of tvo workers who died after 11 years of exposure to the calcined dictomaceous earth dust: `'The lung changes... in the final stage becane a diffuse fibrotic `end hyaline sclerosis fairly similar to that of the tr.ssive quarts silicosis. But ve have noted some important differences from the usual quarts silicosis: lack of hynlinised single or conglomerated nodules and different features of the changes leading to sclerosis. These changes consist in a diffuse cellular thickening of the walls of the lung air spaces, produced by proliferation of dust phagocytes. ' This proliferation becomes gradually so narked that it replaces every eir space and initiates a massive granuloma which only in a very late- Stage becomes fibrotic. Fnckysoma, dilation of bloed capillaries, and hyperplasia-of all the smooth muscle cells of the arterioles and bronchi are secondary phenomena. * * ' "The diffuse distribution of changes in the air spaces somewhat resembles that of askestcais... " Vorwnld (13) describes the lungs of 10 workers (G after death and 2 after surgery), who had exposures "ranging fren two to 23 years." He summarises the pathology as follows: "Although there are scattered foci of hvaliniration and necrosis norc especially, the alveolar walls. These are greatly thickened and oft'on fin e dj tin: rlvrcO.rr r.:r:c*s are c.U'r;.r obliteratici, g d islu rl :ml :v.id .-.wall, r arc aiIl ...4,.. ? io jc-.vr: kysemateus are 'ji.* dll' fi:re COllu'lmr pulmonary f i hrosis s 1: b.! tini most, i: lesio n . I t .i irro :;;*ri our. 1!;*n ':: oisc:v*lv iVwvr.js ur.-o:vii tout: cl r i ] ico sir. nnd is , p\..-- ivrrnn:ll.'itr for the p >.V*.;*lC*r<J ic.;; ir -lory da fJ'i cully nice :c:lured in of 11: ;;*tCS (L:. t'r r.-o fc:.,,s: quart:;, .ini c v i ^ i o : v . - r c Tcuru ;.n i . r ^ V c u r * . : ; U/r-.vr.n- of t! -. rIirf:v;tion Urvr.i r.*n.;:> c" ? - . < * . foavi ::: these ie Lro^J r.rv.l r.o i rlss c :r. 1.: ;.ot do-..;, Jn '.It o'* cases except cr.e, the r'isria s ilic a cer.t'.-::l did *:<*. cxcead ^.y.'f frc.n which he* concludes the "quart:: is rot the primary toxic agc-it... till:* cristo'rulitn or die.Loxite trust be .Lr.sririr.:;t:s." * Since deposits of diatenite contain varying rxour.ts of quartz, the precise type of lesion produced any vary'with. the quarts contest of tec dust. Thus fortiesrui':* (6) cases showed typical quarts siliccsis lesiens in addition to evidence of diatoaaceous earth. These piopl? had been exposed to diatonacesus earth containing significant amounts of quarts. * RathoIo.nc.nl *>.d-f-asults Regardless of the rdr.utiae of pathology, this isoace, li ke ordinary quarts silicosis, sets up the usual vicious circle of effects: fibrosis, cnphyseiaa, right heart embarrassment vith the consequent syaptozs of respiratory and circula tory failure. Susceptibility to Tuberculosis end Other Eosoiratcrv Diseases There is suggestive evidar.ee to indicate that diatoeseeous earth pneumoconiosis predisposes to pulmonary tuberculosis. (23) However, there has.been no adequate study of this question. There is, of course, no evidence for the oft-repeated uyih that diatonaceous earth confers resistance to tuberculosis. On the contrary, those vith the combined diseases have practically a hopeless prognosis. YorvrJLd (13) states, "Our cxpsri.~er.tal results indicate the deleterious effect of the fused calcined product on the course of associated tuberculosis infection. Several of the patients studied had extensive tuberculosis." Doctors for the industry state that there sceas also to be an increased incidence to pneumonia and acute pneumonitis among those vho develop the cor.glon- ' crate lesiens of diaiomaceous earth pneumoconiosis. (26) Role of Different Forms cf Riatonr.ceous Vrrth There arc two priinary types of dir.teracoous earth: (a) the crude or so-called amorphous fern and (b) tha processed fom which has been hunted to high tempera tures end treated vith a flu::, usually solium carbonate. There is agreer.cnt by ell investigator.: that the fluxed and calcined variety, which contains large mounts of as cristohalite, is highly to:1c, norc so than quart?, silica. Tnc x*ole of amorphous diatomite has not teen studied as veil, However, there is good evidence that it is capable of causing disease if there is sufficient expo sure to it. (13,19) PECO- A ll form of the dust cause lung chenge- within a year or rare o#`tr/;-.).~L..TJura.f/jr.e Anr.tr.ncv.n of enrhe;! lung rfcnag.'S have *lavol p .! as c*.r2y r.a s ix months after (!) In f.vu.'ral i t is 1.i.:v.*d that li.e amorphous I'civ car: nroJuae d is v a c lnt- w ill Lake longer to do i t . Jn cv`v ,-; <u! h) crp Tia?rL: by C:.:t\i:;*:r (V)> hu r*.l/-d dini.ov.t.t c!:a!.r:r.- b.vn;; npr.l in l/i.rjrv ./ *., r,u. L:: " .......... c e ll to, rr.o:;.:*.-,!:.-. ..........fibrosis j . r Oi ! i u a b l e I'nr.: I5:* *:: `re: quarts." ii: to.'./.l r: t.a.ti-.-.lil-.- to K? : or t">i. i tv. thaii t_1 u;t* vrarta Vcr.. .Id sxoarizc-s the subj-.cl a:. fcllcr.-s: "Clinical and exynriu.aitnl cvid'.uaa ir.ii.crto that beth crisis ir.d flu:?.'*., d:aicryc-cus earth rrc capable o' .co'iucir.j pul:unary fibrosis, lb-* .letter rare than the fcr::.;r.,: (13)~- Signs nr.i rvr.pte~a 0 In general, thesynptcnc of this disease are siiulcr to those of silicosis and other pneuacccniosc-s cs well r.s pulmonary iuturculcsis. `ho ensot is per.cral.1 insidious with dvr.nr.en. coufh, chest mlr.. .loss of vairrht r.r.d loss of cuoatite. Spontaneous pneusothorax is aucu cars frccusnt in this tliesesse then it is in classical silicosis, cs a result of the forraticn of cayhyserr.tous bullae at the pleural surface. . As the disease progresses, the individual bcccrcs increasingly disabled. Death has ensued in known cases within *a few months to several years froa the onset of cysotocs. ... . . . .* * The icnedictc cause of death ray be heart failure, spontaneous pr.euaothorax, sunerirposed tuberculosis, or other infections, or other pueuaonic or caniio-. .vascular .complications predisposed by the basic lung disease. . .* The course of the disease is generally sore rapid then that of classical silicosis. Vorkers vho stop exposure to the dust after only nlnicnl lur.g changes have taken place cay retard the progress of the disease. On the other hand, the disease ray progress after cessation of exposure at any staga. Superinposition of tuberculosis, of course, worsens the prognosis. X-Ray findings ' ` The earliest lung changes seen are described as "linear exaggeration." Another change often seen is that of fine reticulatier., producing a sort of ground glass appearance. Following this stage there ray be seen evidence cf nodulation, but the nodules in this disease arc not as discrete as those c.f clas sical silicosis. In core severe cases no noduiatio;; nay be detected as the cUsenso advances vlth conglomerate, spreading, coalcscenl lesions. . . r-***>. ;;.s*i * Foitevin (.?.')> of Canada, reports cr. interesting experience with vUalalM:Jo\u; earth in cattle: "These animals ere suffering from infected bladder and the disease vas known locally as fad 1*3Ivr. This cicranc was noted especially is Jlritish Columbia in pasture areas ilccdau every spring and where cattle vero placv:! after the water had rtcedrd. The coil and the gras: vc-rc studied and tkvy were found to contain a. largi: parc.M-.tagc of dinUra c-spnaially rnsr.go solaulus vhii.h cs you kocn; lo:k like .-dies under tj-.e ::inrosocpi. 'iiladdcrs of :.-..vwr:l of the dv.-.J :-::i-:v.lr. u.ro rtu*.Lc.'. in th.: r- r.a vay as a hurar. lur.g air! it v.-.:: feua.i that hirr.InJ.. of s;v:"0 spicules \:crc a : l a c in the tissues ol" luc bl-.JJ-:rs invest: ; tee and u.nv no daunt rcsp.varis'.e fur the infection." J.;;iJv.;S iy t-iy l.' .<1 :J 'f .ho c m '. f'... I'.'iwriMs thor.u; is co"-.2:1. ovid .-.z-.l Uj l -.nti:3 cf th.- dir i.hr:.,.r*.. ..vcu'.rvj.ni.; i.-.;:*."j- /:; ir. a l l types o f paviur.oce-.'.lr.si:., ih r i Y: ?y~~\ h c. r .wl to (bried-.. i up-..\n to :tssoss accurately the decree of di.v.biii ly or t-v to r'. evidence of ilL.v..,-;. A worker r.cy be dive b ln . and. yet sho-.: aiaiual l-rry char.'.s. Convcirciy, there rvzy be ri.ni::al d is a b ility in .the presence of advanced 1 -ray changes. I)xc>:nocic ' Dic-nosis depends upon a * Hislo rv of rv.or.v.rc, nr.d Sim s end svrrntsas o f rnguroaoniosis. The disease can ba easily confused with pulaer.ary tuberculosis. I t tsy also bo lain taken fo r car./ other lup.3 lesio n s. However, there should ba no doubt of the diagnosis of a b ila te ra l lesion characteristic of pneumoconiosis vith or without r.odulaticn and n history of dust exposure to diatcr.zceous earth. Tuberculosis can usually be rules out i f 1:0 bacteriological proof o f the presence c f tubercle b a c illi can be obtained. I f tub-ercl'; b a c illi are found and the other findings ere as above, one rust diagnose the combined diseases. Pulmonary function tests arc valuable in assassins d is a b ility . Treatment There 'is no cure known. Ccrtain proacdurc-s such as ecsitivc pressure therapy cor.bind vith broncrodilaiir.3 di-uis uay ivc leaparary rolid. (20) Aluminum therapy or prepay1a::ir. has r.ot bear. orsvcp. te c: of value, in ordinary sil.iconic a:rd there is no reason,to believe it vosId bo ary mere useful for din tonaccO' IS 'earth. There is cs1 stive evidence that alursinus itself may be heri'Sul. (21,22,21) Thorv havc bean no reports in the literatr.ro of the effects of /.CTil or cor tisvna on this disease. Prey a* ion l*rcvanMon of Ibis dir:rase is lon.t jr.r.sihlc, as is true cf ell occupational dir. It is achieved by useior t!:r: rr.so printdoles as an applied to other dus t disc:..Lm*. These are: # 1 . lirM.ror-.rr.irl c_n5};1!j: n) Ointr.il >!* trie* dust *t. :: * -4r 1..* v:r.t:lalion i'.et , inclv.;irc of ,*i i;r.: .I:*. m - i1/ posr.lbV*. ' 1* j ..... -*-- - . ,,v.to:v. iv. c r .-n l err- tion t.-c-iu^r t*iiy a.xce, and t - - l ro t o il or. e ffio i* .*1. - ........................... lory r.jii:::it. :r.i.;i c) Production arthads r.v.y at tirv:s be olto~-i to c.11air.*,to a toxic exposure, ror cxv.rjlo, one of the uintr-voce^'o er.rth producin'; companies has recently chr.r.jcd ttoir corivouir.g opera lion from an individual suck leader.5 method to the core efficient end cleaner nethod crplcjir.g fork-lift trucks, vhich lift the seeks piled on pellets. 2. Hrcicr.I controlr.: periodic physical examinations includin', chose X-ray and cuLusnery function tests to detect evidence of illness early. 3 Cood lahor-m.anaror.nnt practices a) Joint labor-management health and safety committees vhich verk to assure intelligent participation Ly all personnel in safe and healthful nracticcs. * b) Production policies vhich make it possible for the employees to carry out safe practices. For example, ir. many industries employees are paid "incentive" wages to obtain maximum produc tion. The employee, intent on earning sore, tends to disregard safety precautions vhich slow his work. Tills phenomenon is conacn vhere pay is based on "incentive" or "piece work." . . * * * ' Research Tieedcd Several questions about the disease remain not satisfactorily ansvored: 1. The precise level of dust exposure bnyor.d which harm results. That is, vhat should the "Maximum Allowable Concentration" bn? The ii.A.C. is a useful tool in the public health control of occupational diseases. At present the K.A.C. for quarts silica is used. The evidence new cuegests that if there is a change it trill probably be lower for the processed forms of dintomaceous earth than for quarts. 2. The precise toxicity and relationships of tho amorphous and processed diatcmaccous earth dusts. 3. The relationship of this dust to tuberculosis. /*. The true incidence of the disease in both the producing and consuming industries. A thorough epidemiologic stud/ needed to provide the answer:;. Too State !*::*vi.rout shwrxu of Adult }ali'j i;; CvTncnciiv; such a study with the help of <!.*: j;v, *:w:cn1*1 ::g-;cios lii: in .v;trial -.r'r.ls unioas. Pv ; :;E0 Gl'U'-T.ary 1 . r-.P\Z`: Lar^c air-con teining spaces in the lur." which arc formed by the fusion of ruptured r.ir sacs, often associated with 4 2 Calcine: Process of hosting to high tecceratures to haatin chemical * reaction desired. . i* 3. -Pvr.nnna: Labored or difficult breathing. f. F ib ro sis: Abnormal increase in the growth cf scar tissue. 5. Flux: 'Chemical treatment to hasten reaction desired. In diatcnaceous earth processing, the chcru.cal ordinarily used is soaiua carbonate. 6. Cranulcna: A persistent overgrowth of granulation tissue. Granulation tissue is produced in the initial step of repair cf injured or diseased tissue. 7. : Mvjdnun Allowable Concentration, i.c., the maximum concentration* of material in the air breathed during an S-hour work-day beyond which disease nay result over a period of lino. 6. Pneumothorax: An accumulation cf r.ir in the pleural space which pushes in or collapses all or c part of a lung. A spontaneous pneumothorax arises fron internal causes, and is often the result of rupture of an esanhysenatous bulla on the surface of the lung. 9 Pnlncnarv cnnhrr.er.a: Distention and stretching of the walls cf the cir sacs in the lung. It is found usually in the cuter parts of the lung which have the greatest capacity for expansion, and occurs ns an attcr.pt . to condensate for other parts of the lung which function poorly. 0 * ftp A* 9 U m Ii C M i v m fttfiikli f Xamaftrtl IftHriw 9m Tarft ftriwnHf ftlliwi mai-- 1 OMftt 477 Ffrft vwM ft ! M I4f ftw M h t ftp. l u i AMm M ft*ftkii laftftar, m n U m ft fed M k M ' M f t la ftroM'i fini talarla m a l tt M r T, fejl, ftfta MMiioili xi ptftiDiwy aaoar sftafer ttil ta ftaaai m i w M far ftfta Caaatlaa Q t 4 To rill aaU ftfta* tft aaalaaiata * far 4* aaft tai- afe fidivi Of aaaraa, lift anaUiiai a rwfe f dui >aiaii ftapoai ftftafafepftaaa aaalfta tara awrai u t daca ft* yfefen. mrnm l>f Om t fta fer. ft.*. 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