Document a1ydvK5emb9eXVp8oORw4zkOR

FILE NAME: Merck (MK) DATE: 1943 DOC#: MK002 DOCUMENT DESCRIPTION: Book Excerpt - Other Pneumoconioses [The Principles & Practice of Industrial Medicine t-'- jjt f- The Principles and Practice of INDUSTRIAL MEDICINE Edited by FRED J. WAMPLER, M.D. Professor, Preventive and Industrial Medicine M EDICAL C O LLEG E UK VIRGINIA CONTRIBUTORS Otis L. Anderson Robert A. Kehoe ARn. nNa. MA.ndBearestojner M. H. Kronenbcrg B. E. Kuechle J. J. Bloomfield J. A. Callioun WMialtlathrdewMLauchekieiesli JG.eMor.geCHar.liCsleross RSa.rWah. IM. cMKoereris Donald E. Cumming Kenneth Morse JCohhanrlHes. FF.oEulnggeerl Frank K. Moss C. M. Peterson Augustus Gibson T. Lyle Ilazlett FD.. SF.. RRoosbsietretrson Albert Hemming William A. Sawyer JFo.aFn.naHeJyorhontshon LLooruinis AS.chTwhaormtzpson R. T. Johnstone Fred J. Wampler George Zui Williams A William Wood Book B A l/I'lM O iiE THE WILLIAMS & WILKINS COMPANY 1 M 3 LIST OF CONTRIBUTORS AndeSrusrogeno,nO, tUisniLte.d, BS.tSaote..MP.uDb.l.icF.HAe.aOlt.Ph.Service, .Assistant Chief, Divi MsioanryolfanVde.nereal Diseases, National Institute of Health, Betliesda, AndeDrisroecnt,orRoicfhthaerdDNiv.i,siBon.Ao.f, RMe.hAa.bilitation, Special and Adult Educa tVioirnginoifa.the Virginia State Department of Education, Richmond, BaetAjsesro,cAiantenainMP.h, ySscio.Dlo.gical Hygiene, School of Hygiene and Public BloomHfieealldth, ,J.TJh.e Johns Hopkins University, Baltimore, Maryland. SaSntiatatreys'ERneglaintieoenrs, SUencittieodn,SDtaivteissioPnubolficInHduesatlrtihalSHeryvgicieen, ea,nNdaCtiohineafl, CalhouInns,tiJt.uAte.,oMf H.Dea. lth. Betliesda, Maryland. Mewdaircea.l Director, American Viscose Corporation, Wilmington, Dela CarlMiseldeic, aJl. MD.i,reMct.oDr,. Merck and Company, Rahway, New Jersey; PMreodfeicssinoer, oPfhilIanddeulpsthriiaa,l PMenendsiycilnvea,niaT;emExpelecutUivneivDerisreitcytorS,chBouorleaouf ooff HInedaulsthtr.ial Health and Hygiene, New Jersey State Department CrosAss, sGoceioartegePrHo.f,eMsso.Dr .of Ophthalmology, University of Pennsylvania, GummiGngr,adDuoantealSdchEo.o, lBo.fS.M* edicine, Chester, Pennsylvania. AsosfocIinadteusPtrroiaflesHsoyrg,ieDneep, aUrtnmiveenrtsiotfy MofedCicoilnoera, daondScDhoiroelctoofr,MDeidviicsiinoen, Engel,DCenhvaerrl, eCsoFlo.r,adMo..D. AsisnigstaCnotmMpeadniyc,alEDasirtecPtiotrts,bWuregshti,ngPleionunsscylEvlaencitar.ic and Manufactur F oulMgeedri,cJaol hDnirIeIc.,toMr,.DH.a, sPkhel.lDL.,aFb.oAr.aCto.Pry. of Industrial Toxicology, Wil mMiendgitcoanl,CoDlleelgaewaorfeV; iArgsinsoiac,iaRteichPmroofnedss,oVr irogfinIina.dustrial Medicine, * Deceased Dcocmbei, 1912, X LIST o r CONTRIBUTORS G ib sPohny, sAicuiagnu,sMtuesr,cMk .aDn.d Company, Rahway, New Jersey. HazlMetedti,cTal. LDyirleec,toMr,.DW. estlnghouse Kleetrie and Manufacturing Com pbuanigyl;i,PProefuensssyorlv, ainndiau.strial Hygiene, University of Pittsburgh,Pitta HemPmhinysgi,ciAalnb, eMrte,rcMk .aBn.d, CCho.mB.pany, Rahway, New Jersey. HeyrAostsihs,taFnrtaPnrcoifsesFso.,rMof.DR.esearch Physiology. Kettering Laboratory of ACipnpcliinednaPtih,yOsihoiloo.gy, College of Medicine, University of Cincinnati, JohnSsuopne,rvJiosaorn,nIan,dRu.stNri.al Nursing Division, Employers Mutual Liability JohnstIonnsuer,aRncuethCeormfoprandyT, .M, Ailw.Ba.u,kMee.,DW. isconsin. DiIrLecutpoiriaolf. thLeosDAenpgaerltems.enCt aoliffoOrcnciau;paFtioornmalerDlyiseAassseiss.taOnot ldPernofSestasoter bouf rMghe,dPiceinnen,syUlvnainveiar.sity of Pittsburgh School of Medicine, Pitts KehRoees, oRaoicbherPrtoaf.e,sMso.rDo.f Physiology, Diicctor, Kettering Laboratory of ACipnpcliinednaPtih,yOsihoiloo.gy, College of Medicine, University of Cincinnati, KroCnehxiebfe, rDgi,viMsioilntoofn IInId.,usMtri.Dal. Hygiene, and Industrial Medical Super vPirsoofre,ssDorepoafrBtmacetnetrioolfogPyubalnicd PHueballitch,HSeataltthe, oUfnIilvleinrsoiitsy; oAf sIslilsintaonist KuechCleh,icBa.goE,., IAll.iBno. is. / ViIcnes-uPrraensicdeenCtoamnpdanCyl,aiWmasusMaua,naWgeisrc,onEsminp.loyers Mutual Liability / LuckDieirsehc,toMr,aLtitghhetiwng, DR.Resoe.a, rDch.EL. aboratorv, General Electric Company, Nela Park, Cleveland, Ohio. MacAiislseo,cWiaitellParrodfc,sMbo.iDo. i Research Physiology, Associate Director, Ket tUenriinvgersLitayboofraCtoinrycinonfatAi, pCpilniecdinnPahtyi,siOohloiog.y, College of Medicine, M cKee, R. W., Pri.l). InsUtrnuivcetorsritiyn, IBnodsutosntr,iaMl eITs-.a\geihcnues,etStsc.liuul uf Public Health, Ilaivaul I;' LIST OF CONTHllW TOKS XI M orPrrios,feSsasorrahofIP.,reMve.Dnt.i,vFe.AM.Ced.Pic.ine, Womans Medical College of Penn sylvania, Philadelphia, Pennsylvania. M orIsned,uKsternianleEthn,gMin.eSd., Division of Indusuial Hygiene, Illinois State Department of Public Health, Chicago, Illinois. MosPs,hyFsricainskt, LKig, hEti.nEg. Research Laboratory, General Electric Company, PetersNoenl,aCP.aMrk.,, CMle.Dve.land, Ohio. Setciroenta, rCyh, icCaoguon,cIilllinoonisI.ndustrial Health, American Medical Associa RobeArstssoocina,teD.MFe.d,icMal.DD. irector, Merck and Company, Rahway, New Jersey. R ossiter, Frank S., M.D. MePdeincnaslylvDainreiac.tor, Carnegic-Illinois Steel Company, Pittsburgh, SawyMeerd,iWcalilDliiaremctAor.,, MEa.Dst.man Kodak Company, Rochester, New York. SchwMaerdtizc,aLl oDuirrse,ctMor.,DU. nited States Public Health Service, and Chief, NDaetrimonataolsIenssItintvuetestiogfaHtieoanlsthS,eBctcitohne,sDdaiv, iMsioanryloafnIdn.dustrial Hygiene, ThomDpirseocnt,oLr,oPrionpuAl.a,tiPohn.DS.tudy, Virginia State Planning Board, Rich W amplmeorn, dF,rVedirgJin,iaM. .A., M.D., M.P.H. ProOfeusts-Pora,tiePnretvCelnintiivce, MaenddicIanldCuosltlreigael oMf Vediricgiinneia,; aHnedalAthdmCoinnissutrlatatonrt,, WilliaSmosu,thGeeronrBoeiscZuuitr.CMomDpany, Richmond, Virginia. Asmsoocniadt,eVPirrogfiensiaso; rMoefmPbaethr oolfoAgyrm, eMdeFdoicraclesC, oLllte.gCeoomf.VUir.Sgi.nNia.M, R.Cic.Rh. 372 PRINCIPLES AND PRACTICE OF INDUSTRIAL MEDICINE VII. OTHER PNEUMOCONIOSES There is considerable disagreement in the medical literature concerning the exact etiology of certain types of pulmonary fibrosis due to dust inhalation other than silica dust. Asbestosis, siderosis, and anthracosis are the most important of these fibroses. , Asbestosis It has been well proven that a peculiar type of linear pulmonary fibrosis is caused by minute asbestos fibers inhaled by workers in industries utilizing asbestos for the manufacture of fire resisting material, insulation, certain fabrics and ropes, paints, roofing, tile, etc., as well as the manufacture of asbestos itself. Asbestos is magnesium silicate and is the only silicate which has experi mentally been proven to produce a pulmonary fibrosis without exposure to silica. The onset and clinical course of asbestosis is similar to that of slowly progressing silicosis j.nd the symptoms in the later stages are identical. Fatal termination is usually by complicating pneumonitis, cardio-vascular decompensation, or tuberculosis. The roentgenopathology is typical and not difficult to differentiate from silicosis. Gloyne and Merewether state that the roentgenological appearances of asbestosis are revealed typically as a general lack of translucency with a fine pinhead mottling. This is the characteristic "ground glass" appearance. The film should always be compared with a film of a normal patient and a film of a silicotic patient taken with the same exposure. The diagnosis depends upon a definite history of exposure to asbestos dust including sufficient period of exposure, roentgenological appearance, decreased pulmonary capacity, and the finding of asbestos bodies in the sputum of patients not yet removed from exposure to the dust. These asbestos bodies are well described and usually illustrated in most text books of clinical pathology. The pathology may be summarized-in the single statement that it consists of a persistent, progressive, diffuse perialveolar fibrosis of the lungs. The fibers may be seen on histological examination to lie embedded in the fibrous walls of alveoli and bronchioli and each fiber appears to be encrusted by an iron-containing yellow pigment. As would be expected, in the later stages the fibrosis becomes confluent and massive. . ,, Siderosis Siderosis is chiefly a red pigmentation of the lung tissue due to inhalation of iron-containing dust frequently found in hematite miners. Experi mentally, fibrosis has not been produced by pure iron or iron oxide dust PNEUMOCONIOSIS 373 and only when mixed with hazardous concentrations of silica dust does " fibrosis result. Therefore; unless the patient is also affected with silicosis... siderosis by itself clinical findings. is asymptomatic and produces no roentgenological1>of r}*^" Anthracosis ' Black pigmentation of the lungs due to inhalation of smoke and other* types of carbon particles is common particularly in residents of large" ? industrial cities. Most marked blackening is produced in coal miners./ T; There is some controversy concerning the question as to whether or not O' carbon dust of itself can produce a pulmonary fibrosis. There is no con- elusive experimental evidence that pure carbon dust will produce fibrosis. It is the author's opinion that all instances of fibrosis in anthracotic lungs are due to an admixture of silica dust in the inhaled air or an inflammatory -'AV fibrosis due to respiratory disease. Anthracosis is asymptomatic and produces no clinical findings or disability. REFERENCES .- American Public Health Association: Report (joint) of the Committee on Pneumo tcioonniaolsiDs iasnedastehs,e YCeoamr mBiototeke, o19n33S,tapn.d1a0r0d. Practic'es in Compensation of Oc. c.upa- -- Belt, T. H., I rwin, D., and K ing, E. J .: Silicon and dust deposits in the tissues of < persons without occupational exposure to siliceous dusts. Canadian Med. Assoc. J., 34 (2): 125-133, 1936. Burke, H. E .: The detection of mineral particles in the sputum in silicosis. J. Ind. C o lHe , yLg.., G1.,7:an2d7, 1935. Cole, W. G.: Dyspnea of silicosis: What causes it? J. A. M' . A.; 113: 1216,1939. - Cummins, S. L.: The augmentation of action of anthracite and other dusts by dead D r i ntukbeerr,cPle., bacilli. and H a tBchri,tT. .J: . IEnxdpu.stPriaatlhD., u2s1t:. 64M-7e0G, rFaewb-.H1i9ll4,01. 936. ` ' E llman, P .: Pulmonary asbestosis: its clinical, radiological and pathological fea- . tures, and associated risk of tuberculous infection. J. Ind. Hyg., 15: 165, 1933. G ardner, L. U .: Pathology of so-called acute silicosis. Am. J. Pub. Health, 23: Gar1d2n4e0r, ,19L3.3.U .: The pathology and roentgenographic manifestations of pneumo coniosis. J. A. M. A., 114: 535-545, Feb. 17, 1940. Gardner, L. U .: Recent developments in relation to silicosis. Ind. Med., 9: 45-49, GarFdenbe.r,19L4.0.U .: Studies on experimental pneumonokoniosis. Y. The reactivatfion " of healing primary tubercles in the lung by the inhalation of quartz, granite, and ~ carborundum dusts. Am. Rev. of Tuberc., 20 (6), 833, (Dec. 1929). ' if Gloyne, S. R., and M ehewether, E. R. A.: Asbestosis. O. & H., (Brochure), 1938i H atqcuh,aTnt.,itaantidonT hfoormrposuotnin, eE.pWlan.:tAoprearpaidtiomne.thIobdido.f,d1u6s:t9s2a,m19p3l4in. g and approxim. ate - Ww International Labour Offic e: Pneumoconiosis, a list of references, studies and-, reports, scries F (Ind. Hyg.), No. 15, 1932.