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Q PLAINTIFF'S EXHIBIT AB-77 Chest Conditions Simulating Silicosis L. E. HAMLIN, M.D., F.A.C.S., Medical'Director, American Brake Shoe Company, Chicago N recent years the recognition of true occupational is questionable. A few cases have been reported from I fibrosis has become more difficult because of an Eastern textile mills but after a very thorough inves ever increasing number of conditions which produce tigation of the cotton industry in Mississippi in 1944, patterns, in the roentgenogram resembling silicosis. Ritter and Nussbaum were unable to demonstrate any These are by no means confined to diseases caused by x-ray findings Characteristic of the disease, either in the inhalation of dust but range ail the way from cer employees in the cotton mills or in the files of private tain heart afflictions to the exaggerated linear mark roentgenologists or the State Tuberculosis Sanatorium. ings representing vascular changes in the lungs They did find certian allergic individuals who showed associated with advancing age. Their careful ap very definite asthmatic reaction to higji.concentrations praisal as a health consideration as well as an indus of cotton dust, but otherwise .clinical evidence, was trial complication therefore becomes more essential lacking. Postmortem and histological examinations re as new complexities appear. vealed nothing of a specific nature. They concluded The following classification of diseases whose x-ray that "no evidence was found to clarify or even support pattern may be confused with that of silicosis is offered the existence of byssinosis as a clinical entity arising, not as a complete listing but as one which includes among employees exposed to Upland cotton in a cross those derived from a search of the available literature. section of that industry in Mississippi." Mycotic infections have been placed in the non-indus Bagassosis is.the name given to an industrial disease trial group because the majority of them occur without observed in a few workers in the sugar-cane industry. any relationship to specific occupations. However, they The disease is described by Caatleden and Hamilton- do result, in some instances, from occupational ex Patterson and also Gillison and Taylor in the British posure. Medical Journal in 1942. They state that "bagasse," a waste product after the sugar has been extracted, is ..Chest Conditions Whose X-rays Simulate Silicosis A. Industrial : I. Organic II. Inorganic . (Inert) ; (a)' Byssinosis (b) Bagassosis'' (c) Tabacosis (a) Anthracosis (b) Radiopaque Deposits-- . Barium (Baritosis) Iron (Siderosis) used in the manufacture of board. The material is crushed or shredded into small fragments, the fibres of which contain about 1% protein and 6 to 1%. silica. Symptoms after one to two months' exposure, con sisted of dyspnoea, cyanosis, violent cough, scanty sputum, occasionally blood streaked, and mild eleva tion1 of temperature. The.x-ray suggested a bilateral pneumonia of the influenzal type which either resolved completely after several weeks or left the patient with Tin some degree of residual fibrosis. As in the case of (Toxic) (c) Beryllium ' ' (Proliferative) (d) Asbestosis B. Non-Industrial I. Mycotic (a) Aspergillosis (b) Moniliasis"- . (Yeasts . .(c) Wood dust spores and (d) Coccidioidomycosis Molds). (e) Blastomycosis . (f). Actinomycosis . .... TI. Miscellaneous (a) Miliary tuberculosis byssinosis an allergic response in the lungs to this dust was a definite, possibility... . Tabacosis has been .described , as far back as 186B as producing disease in the lungs. However, very few cases seem to. have been reported. In Argentina, and Brazil the condition is considered an occupational dis ease and is compensable. C. F. Long, after a period of 10 years experience among 4,000 workers in the tobacco industry, made: a special investigation, of over 1,247 (b) Sarcoidosis who had been subjected to tobacco dust and compared (c) Mitral Stenosis . - them. to. 1,007 who had never been exposed. He con (d) Cancer (Metastases) (e) Vascular changes (f). Miliary calcicosis (Wheatena) (g) Polycythaewia Vera cluded that "Tabacosis does not develop in the lungs of those who inhale tobacco dust." Some inorganic. dusts produce alterations in the lungs which are represented by a mild accentuation of Since the year 1818 certain pulmonary conditions are believed to have developed as a result of exposure to dust in the cotton industry.- Reports from Europe as well as from this country indicate that prolonged ex posure to high concentrations of cotton dust have caused definite symptoms and permanent-disability. In England the Byssinosis Act of 1940 awards-compen sation for total disability following periods of exposure in cotton mills up to 20 years. In the United States the existence of byssinosis as an occupational disease ------- '<!. Presented at the Annual Meeting of the American Association Industrial Physicians and Surgeons at Chicago. AdtII U. 194S. the linear., markings in the x-ray. Included in this group are dusts from such materials as limestone, marble, talc, chalk, calcined magnesium for insulation, furnace linings, carbon and cement Since they are relatively inert and non-productive of symptoms, their presence is only detectable by x-ray and the shadows observed may resemble the exaggerated lineal pattern of pre-si!icotic stages. Dusts from substances like barium, iron and tin, can result in radiopaque deposits in the perivascular lymphatics and interalveolar septa which cast shadows in the roentgenogram closely simulating those of dis crete, nodular silicosis. The deposits have real sig- SPNY 000235