Document aeZz261nyXQ72yEqbXp1qRGB

.. Vd.29 . 1 :'-C'2oOO'44v; . ^1:: Asbestosis* R. R. SAYERS, M.D., FA-P.HAu ' W. C DREESSEN. Senior Surgeon, and Passed Assistant Health Service, Washingto ASBESTOS is well adapted for use pathological report on asbestosis pubas a textile material because of lashed in the United States, and in the' ;a fibrous nature. On account ol thiss,ame year, 1930, Lynch and SmithT ." as well as its non-combustible and ex reported on asbestosis bodies found in. , igent insulating properties, it has come the sputum of asbestos workers. / to be used in ever increasing quantities The Public Health Service was re u during the past 20 /ears. Hence, it quested by the State Board of Health *, ; is not surprising that Gloyne and Mere* and the Industrial Commission (Ad- *eiher1 should refer to pulmonary ministrator of the Workmen's Compen- . - asbestosis as a u modem disease." ation Act) of North Carolina to assist . The first record of a case of asbesto- them.in making an engineering and'* * sis $eems to have been made by Monta- medical study of the health hazards i>, ue Murray in 1900. The first com in the asbestos textile industry of that _ plete description of the disease and of state. The objectives of this study. > >1; . r' ?V the u curious bodies " seen in lung tissue and sputum appeared in 1927 when Cooke2 and McDonald3 reported 2 ciffg? of asbestosis and listed their reasons for betieving that asbestosis bodies originate from asbestos . fibers that reach the lungs. Their papers aroused general interest in the subject and numerous others appeared soon afterward. Hoffman4 appears to have were: - '? !; L. To make a mrdfel study el the' rtferts:'* of Iong<Ofliinaird of asbestos dust. ; oa Use buoas body. . * 2. To identify the manufacturing processes tint create dust, and to reeosacad ptactfcia for rcduo&g the dust exposure of weriem.- > , . J. To fiad out what conecstratioas of u- twstos dust oa be toicnicd without injury. . It is the purpose of this paper to review briefly the priaepuf findings of this icudy.* . been the first American to call atten tion to the magnitude of the asbestosis . orczNEEiUKO. totodtcs . The main asbestos raw material used problem. In 1913 he reported that 13 for textiles is Canadian ehrysotile, 'i* deaths from asbestosis had occurred among asbestos textile workers, and about the same time Pancoast, Miller, and LandisJ reported on 17 cases of which is a hydrated magnesium silicate containing no quartz. The textile manipulations of asbestos are very similar to the production of asbestosis. Mills's8 paper was the first cotton or woolen goods. The crude fiber is sent first to the preparation de * tnd Mm TMfcnirial Hyw S*roo* l ite partment, then, in the order named, / Amtiu* Amncmwa it tb* Ji? to the carding machines, spinning w.%-muIMh SA.anai Umt*t >* Kimm C!iy, Xta^ Ocutow frames, winding bobbins, twisting ma- (Sl 'KV . A^-v . ; . *^? . * * . . ' ** . W* ' AM YoL29 . Asbzstosxs * ; . 207 /- .. Tab* I . 4 . . . Sommon of RtPdtt jbm( Iko Sspotms of Asbestos Tests* Workers Under ControBed omdJJncontioStd Workmg Conditions .. t .- ' SluipmasU ' .. Wfitowiag (oponing) Pffiogt Picking Carding (primary) Carding (roving) . Spoofing Weaving (broadlooa) Bnahcr ealendanr '* Dust Comm , ' * yoi*mo/ eoUrotion Wmmbor ofAir WUh .of Duet SemdUd shosut Commodious ' (CfM) (MPPCf) ' .' * 2 $23-4,000 1 . 13S * a . 2470 s . 4 ' . 1440 J U '` 46.3 2 * ' 1400 * 3 ` * 1450 * . 3.4 3.0 4.7 2.0 . 2.9 .r 1.0 . " Dmst Com mutation Without Sskomst U.I-46.0 4.4 34.3-74.S RJ . . 13.3 4.7-49.7 1U. * Eqvipperf' fUr pe--ilk amft. t bia r wfifWiii. ' ilatintei com iae tack ipaai u4 ommmoot (a ctktt sasSdd. chines, spooling frames, and finally to up of particulate matter and fibers. the looms and miscellaneous fabricat TTie median size in microns of partica- ing devices. - late matter ranged from lJSS to 2.40. In ail, 242 dost counts were made Particles were smallest in the carding m estimating the exposure of there and preparation processes, and largest asbestos workers. `Only summary en in weaving. The median length of gineering findings, or dust concentre* fibers in microns ranged from 7 to dims as they relate to. medical find 16-3. As might be expected, the long ings, will be Summarised est (400 *0 were noted in case of weav remits of dust concentrations under ing and the shortest in preparation. controlled and uncontrolled conditions Tab* IX * '*-> appear in Table L It will be noted that ?4J million particles per cubic foot Mtdiom Ztmftk of FIbm SampUd WUk m Owe** J4 Apparatus is the maximum concen tration of dust encountered. Even this maximum figure is much lower than is \ VodSOM Leoftkof fibersba r is. frequently encountered in other sfliee- Activity Microns o trades where it has not been un WHIowing 7.0 common to www'wnw Anrt concentrations of 1,000 tn.p.p.c.f. Picking Carding Twisting * ` . 94 U U4 The dust in asbestos plants is made Weaving (broadlooa) 14^ '.Tan nx ftrqurncp Dtstr&nd*oa of fartiadat* Dost Susp*nd*d a* Ik* Air of Asbestos Tftiit* ?U*ts *7- ** /wyq / tfi foHitd* She Crimp <im Uktmms) ***# WoT*Oea Utdm* Cmw<h4 9 9J 1 u 2 2J 5 JJ 4 4J S ShoT* StuUord to to to to to to to to to to m itkw) OremOm 0.40 OJO Li* U9 ISO U9 J.*f JJ0 4.49 4JO More To*o t.tt 1.54 5 21 57 22 10 4 2 1 0 9 9 100 A"' Ui l.JO 1.27 I.JJ i 2* 2S 9 10 4 5 1 $ 2 109 9 t 25 54 24 4 1 t 1 9 1 100 ***** lfW,n (cWu^wmd)ri4) t.22 1.55 - 2.40 2-74 1-31 1.44 S 50 24 14 f $ 4 5 9 l 5 100 X 4 47 27 to 5 2 5 4 9 5 100 0 t 11 24 14 U 7 15 7 5 0 too I . -, ; ... *.* ^ % \ . %* . %. , . . Vi;- ^v; . ; .;%:.vVV\..V:v*:.`*7 -:>/>* ^V^*-/-`i .. * . j .**.* ' ----*-* - -, .:* ,v. V' 'l . . * *.>. . ' . . . *<- '\ * \," t :*v* -*; j~- - ., i^t 1-- OF ?UBXC HEALTH U*r^2939 . -v in the course of subsequent discussion. The workers who were found par ticularly liable to develop severe forms ` asbestosis were the wfilowers, pickV..e, carders, mule and ring spinners; Their exfoflows: Swat CTncratnUon MP?CF .J-J6.0 study, approxi mately 130 workers were rqiiami by ^ . ' hew ones with little or no asbestos ex perience. . As a consequence, there was *-^It1w4j,V-''*!* - .?***V abnormally large potentate of work- * with less than $ yearn* employment ) {**:-' h* the asbestos textile industry and an ' ` ` ` abnormally small percentage who had ' ' or more in the Indus- than 200 had worked at occupations in cotton or plants, but exposures to ' pneumoconiosis producing dusts were 1 1'*'.' *+ ' * incoaseauentiai. N, ' *3 J Characteristics of asbestosis--Tulmo- \X A i * - nary asbestosis was the principal physi- ' * "`>f - ' ' cai defect found on examining the 541 ;:sr^ persons. This disease, a form of pneumoconiosis caused by long con 'b'/r-fr* \ -`t tinued inhalation of asbestos dust, is rhararteriad pathologically by diffuse ateestital sobnoaary fibrosis and the :cmnce of asbestosis bodies In the may. <**firir?My, the chief symptoms are progrum dyspnea, variable cough, absternal aest pain, blood streaked guaum, degrrased expansioe, cnatriatitan, weakness, dabbed fingers, ar cawed nart. late ta the disease, the dyspnea beixues distressing, cyanosis ear ssr, x=d there- may be severe pareayms f coughing productive of tmagimrt spattsa. The characteristic erg 2Z-cay shows granular or ground gaso marka^s with more or less obliteration of usual linear puimcoic Housings, krafirrd is mid-lung and bases. ,Tbe grainy appearance may brciama quzs generaihed with eri- dses of espeysetna. usually in the apices. Macular or aodaio-congiom- emle sbadovs of *&**r**z* are ink ocaerred, bet whether this is due to a pecn&acty of asbestos dust or to rare jemrrena of extremely high dust esosures. it i zstpossible to say. Shag* ps& of the heart shadow is not in* frequently oiserved and seems to be most enmome is workers exposed to s high jrwsorrim <*f fiber twisting, brsaddoth wearing}. By duoroscopy, dcaiTcfvwd esasrsion of diaphragm is seen. Teabag deformities of dia- pem^m, bowrrer, occur les frequently thsn in silicaaa, Asbestosis bodies found in the lungs and sputum ms characteristic. There is ocd eridens that these bodies ori^- nace as a rrfuar response to inhaied fibem.' Asbetcsis bodies consist of a core of asbesrw fiber surrounded by iroa-esntainint rwulein deposits. They are goinen yelow in color, and do nut staai with orimary histologic stains but bessrse IriHant blue when treated wuh cctasxhnr iairreyanide. They are variable in fans and she and dtarac* tersuaolly are slender, dongated, seg* iimted stntca.es with bulbous emis whjch fire thss a dumbbell or drunt- cfc shape (Figure H). Oeosionally rk<d or Y-shaped body is observed. >*y range from 10 to 130 ? in length, fnging about SS yu U has been suggested that damage (he lungs occurs while the body is nS formed, but once the body is TMi the liber in the core is rendered rt hy its coating of iron.18 The find- the sputum of dumped asbes* bo/*:-s Jn radial pattern or rosette '(Figure HJS), which is common in lung sections, has been suggested by Stewart, Tatteraall, and Haridowu as a dear indication of disintegration of lung tissue whether by a process of simple suppurative broncho-pneumonia, or as a result of secondary tuberculous infec tion. In either case, they feel, that it strongly indicates a definite underlying asbestosis. On singie sputum specimen analysts 'j v I* lr.w . -&. I* 212 Amzsicaj* Jocxhal o? Public Health ,V-'.4 #r, zpjp .iAtf&* - * ) Jr.. Tsobs XV--?reenUf* of Aobcsao Trrrflo. Wockm, Oaiiifini by Aveng* Dual * Canrmtration (Masond m HSBoa Tvseia per ea. ft) ami Dotation of Espouut, Fgqad to Have QwtfSai Lung-Fid* Maxfcia^ . . . * :m, . i Hif V*J ^ 2i r*1>5/^^r--Vr' *j* >k r i'T '...`-kAv"w-2t`. i>v ;#-WVv-vy T^,\ YoL29 be mad that, (h asbestos ing let hlcConr similar creases tion. but few esposun are nec premier. several indudec SAKE IX ./ - a .* r _ ... ^i.- ; .> *y - *", ' .' "1 V :'. . ."**} *' ;j**T ` ". * a probably due to total- amount e * asbestos (bat inhaW, Diffssce is -.amount of physical exstioa say play " an important role--a person in a series . tary Job baring a snaHer seed for oxygen inhales lea air and esnseqoentiy fewer particles of asbestos. It was noted that the relation between dust- exposure and the UKimrTyr. oi iiitev.--. ground glass lung field nmfcjjgn was H Ul::^'y not a simple one. Even who length of employment ms disregarded, it was Sift; found that incidence of these aaririags was proportionately lower at 10 to 19.9 V: ai.p.p.c.f. than it was at the next higher-? or next lower concentrations. Although r t s probable that these differences rep--v resented sampling errors due to. small j. numbers of exposed persons, it maybe**/ that asbestos fiber exdtes a different Iand possibly more severe reaction than asbestos particles. ~i v *2- On account of large labor* turnover, as well as the short time that the; ^ plants had been in operation, no exact*';, estimate of incidence of asbestosis can "?.' `* / ..iferV. *i SS'*I fiJ. *1- - r.^v*>.-. _--. -f. . \ - Ji:., mt-V- n i. Vj i-v *//' r I--. . * U-u>: ^ j I * * * y'v ^ .V -V-- r 1 Ocewmes of - Xus IV .YSiC- in Zriatw to Dm* Concentration and Lc*ttk of 2mplaymcnt:-r~ ' ` . PuXAnJaf* Vtt. k. Asbcstosu . .V*-. i*. Toon in Atbcstos Industry :*t- v Dost Espoamn,Jf3Bon ?arttdg forCubic Fool StoU $U9J v,,w- b OwriO v- : * AgfCUrt 0 to 4.9..................................... .. Espowi t' \ ) 'Affected 4 to 9.9...........................................-i TT~m~r! Pcrcesat* r Attest* Ovr to...............................Trpmr^ ^ Prn-rriigg .- ' ` ' 2 S4 3^. Q TO 0% X 124 4% X 19 s% 6 n 14* 23 43 si% 0 ... f.;V. S .K a*-f S3 f 19 *5 ' 1 a&r- 1 * 2i ' ~ I 36 '1 ft I ` ^r*r'?v * For (o have conditio central dust c produce healthy working interpre difficult, exposed bestosis ployed doubUu 2^ to Becat Fermi*-, Court7 Testiit: Heatm **d /. Canin 3/aZtow FerCu *H*er JO S to 9.9 :-s to 4 2 r Hu* V Y*L29 Asbestoszs -------*:, be made, Table IV shows, however, rnmt, tjBi ibe percentage of persons with xbeslt** increases greatly with increas- . isg length uf employment. Lana, jjcConneiU and Fehad,s reported a *... :..vnett* - juntlar trend. The mddence also inftfose* with increasing dust concentra TOSjfagUkmgnMrinyitiifrsgjfy V*v ^ tion. For the reason that there are . bat fe vases with more than 15 >'eats,'^SS^S5S535t a . . :** - epwore. the percentages in Table IV ---TM* flu snuvieu . . . j . ~, . .*.*:r,/; xt necessarily minimal estimates of thagf^aeaa^at^'dw idwiitiablacvgfdttce^ s^T ^`k|-!^:.:- %K&n- prevalence of asbestoses even though ralnaioniy ;\ * ' **. *. * *. . several if the former employees are included. t'i.v jatc limits or cctosuss to asbestos J3T far practical purposes it s useful .to have a definition of safe working condition*. Ideally, a threshold concentnttua of dust should be the highest dost concentration that would not produce pneumoconiosis In originally besllizr workmen during their entire working life. Below 2.5 ntp.p.ci. the <3F&as& *: . . ,,\V . ; conclusions '. -^*i* As in other forma of pneumoconiosis, occupational history, and daical and* X*y be can should penerwra since the Job designation re- : >, l ; d* * ", ... iu - ; * v * - ` A .. \ plovrd store than S years. Three twist, and doth weave. Confirmation of doubtful cases of ashestnsis feB in range the hazardous nature of some of these' tS to 4.9 tapgcJ. Tamx- V fiwteerx / IFo^m Exposed lo Ctriain Caormtreiiom of AsbeUo* Dost in Asfsrstot T*itde fWiw ITim Oms< Co<n*< J/nm 4r* t*W re < Limited Extern* **4 in 5vt0nn U'iT* Efretfve Dm* Coatroi Is Fraethrd UmUtd Vse Z>vr Ccemerretwn of Oustiisn*m Certifies Coeirei p*rC*6ir F*m Mtmmes * Over 10 5 ia re 44 2* l* 4/, If Cadtr -J 9 Estmaw Use f DmtCentral ifamvwf 7 17 39 44 occupations is the frequency with which *'the occupational designation of carder, ~ ' ; V. >*V. * weaver, or spinner is encountered in > -- *: ' autopsy reports of eases.1*"1* The foi- *' * -* ' ` * 4 ' Carofim textile mills, pnimooary aabeatotis wi the priDGpal physiol defect found. 2. Tho meet serious feme of the disco* ' 1 were abscnul in orders, spiaacn, weaves, , twcWon, wittowers, sad pickets. .<* . . J... 3. Exposures ranged froo QiO to_'*76' V m.p,p^.f. ' ,. . '' ' 4. 4. Oust of sir la asbestos** * textile plants are both partfeulau sad fibrous. ' ' S. It is iapenlive that finding of occupar lioaai history, mminatioa, sad X-ray ' film aH be ouwidwed ia making diagnosis of s ' _v;** 1 .* " *U 4 \ .. m~ i.. I *Utow-a fImmm nTaim*.*aeeatV.U. 4. Oefiaiie dfniol sad roaatgcaogiaphic. ti; I t :.i :l j.. 4 I .V I i . . r 4 ' ------; -- - - ;- --n'-i ZmZ.t 4 * . h./;'<? r-- - American Journal of Public Health Jfr, aw- K-lm ' " ; .jY;yyi *. . ... * r kUnUr." . .v > te ,*::;; rridenci of ubcstoHJ b observed in eapooed persons titer 3 to 10 yeen of work in eapotttm qcecdtn^ S am.p.ci. 7. It sppenrs that if osbeMoo dost enneentmtims in the air breathed are kept below 3 m* ate of literate* win nut *peppp*ar. *CM ethods for cnotroiCag the dust below thii irjtekfiw^thiuhoJ^ art already available foMnesl of the pracesas in the industry. umstca . V-.5';!-Y> * * uL o6troe. A L. aad Mtft mini. E. X. A ; -f 7<:n .4i * AteUotaorw. Oumftim **d !*<** . ' .-V . V Pfir v* - . ` = **V ' !),/* 5*' >*.* T2Tirr--` Litwf OSce. Orecre. i-w*. 2. Crete. V. . Mmmi? 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