Document e5eE4eKkn7n1zq3BBBeXYzQDm

162 PLAINTIFF'S DANGEROUS DUSTS--HAWES 1 EXHIBIT f EPG-11 / DANGEROUS DUSTS'* N. E. J. OF M. JAN. '*, 1037 rv .if!ix u. ii.uvi;-, 2xi>. ir.o.t fjplIK subject, on which l ;iiu to is im- Anotl.iT ca-'1 was that "C a man who had de 5. portant 1`or two reasons, hi the lir-it. pbico, veloped tuberculosis. llo hail worked as a out tor this question of dust, ilaimrfous or otlo rwis'1. of o',lion rlcitli with sei.wu's and with a nun-ii ine const itutes 11)0 ino-t important problem ill t!i'.`j in one of the most limb-crude private eharitabV whole tii Id of industrial medicine and, second': eiilerprisos for the handicapped that I know ai' Iv, dust is the source of one uf the most vicious ; in Boston. He was under the care of a well- "rackets" indicted on this country. This hitter known and competent physician. In going over I will describe briefly. lite dies of This case I read a letter from this The basis of this racket is founded on (1) ig physician to the effect that his patient's oxpoMiio norance cm tiic part of the workingman, (2) ig to this cotton dust, inhaled in the course of his norance on the part of doctors as to what dusts work, might well have led to pneumoconiosis and are dangerous and (3) unscrupulous and nier- j should therefore be considered a possible cause ccnary lawyers. The average workman is well of his tuberculosis. Naturally, I had inspected aware that the granite cutter, who has been ex the promises where this man worked and knew posed to granite dust and lias been disabled that the dust was conspicuous by its absence and thereby, quite properly receives compensation, as that the quarters were light, airy, clean and well does the sandblaster and, in many instances. Hie ventilated; by no conceivable chance could the foundry worker. Naturally, the laborer is in no dust have been in any way a cause oE his illness. position to make a distinction between the vari These are examples of what I believe to be ous varieties of dust, innocuous or dangerous. ignorance on the part of physicians desiring to All dusts look alike to him. Therefore, ili in flic help out their patients. The following ease is course of bis work in a lime kiln, a textile fac rather different. A man in a certain very large tory or flour mill or elsewhere, be comes down indushv in this country may be exposed in the with bronchitis, bronchiectasis, asthma, tubercu course of his work to minimal amounts of rust or losis or something similar, lie very naturally iron dust, which is beneficial rather than harm argues that, it was the dust that caused it and ful, equally minimal amounts of lime, which claims damages. This brings us to the second contains a microscopic amount of a harmless reason for this racket, which is likewise based on silicate (lime in fact is often advocated in treat ignorance--ignorance on the part of the medi ment) and some powdered soap, one of the in cal profession as to what constitutes a dangerous gredients of which is a silicate, perfectly harm dust and as to the difference between the general less in such minimal quantities. The powdered term, pneumoconiosis, and the specific one, sili soap is used for lubricating iron or steel wire cosis. Of the many physicians whose testimony as it is drawn through a die. It should be borne I have listened to in such cases I know of only in mind that this soap was a lubricant and in no one that I feel is actuated by mercenary mo way an abrasive, as an abrasive soap would have tives fur testifying as lie docs. In the vast ma ruined the wire. The physician I have in mind I jority of instances of this kind, doctors are testi testified in five of these cases, in which I like fying for their clients with honest and sincere wise appeared. In one case the autopsy showed motives. A few examples of this might well he that the man had died of cardiorenal disease given here. with no trace of silicosis in his lungs, but it was A physician, whom I have known for 30 years claimed that the man had had silicosis and that as an intimate friend and a high-grade general this was responsible fr>r his death. Ilig testi practitioner, testified in my presence that a cer mony in the other cases was along similar lines. tain man who had been working in a woolen Of this nothing further need be said. mill had acquired a chronic asthmatic bronchitis The third factor, and the most important one because othe dust to which lie was exposed in in the development of this racket, is the crooked the course' of his work. He had never inspected and mercenary attorney. One of the very large the mill itself. Aside from the fact that wool industries in this country, that of cement- dust is perfectly innocuous and never has caused making, where workers may be exposed to one of any serious disease, I personally had inspected the harmless silicate dusts, has been subjected this mill which was situated in one of the sub to attacks on this basis with the result that ver urbs of Boston and had found the conditions dicts of $15,000, $20,000 and $25,000 have been there to be the most hygienic that one could ex awarded to the plaintiffs, with cases said to 1O pect. There was practically no dust. amount to over $12,000,000 now pending! Clever Rend before thi. meeting of th American Clinical and lawyers with able assistants, a hired group of 1939.Climatological Amocfatton at Richmond. Virginia, October -7, witnesses and unscrupulous physicians were able fllawds, John B.. 2nd--Prfuldent, Bouton Tuberculosis Asso to carry on this remunerative occupation for a i, ciation. For record and uddress of author see "This Week's Issue,1* page 180. very long time before the manufacturers com- DF- M. ..1037 i de ft cutter machine lftrifftble know of ft well ing over om this xposiue ic of.' hic os is ftiul 1c cause ispected id know nee and md well uld the . illness, e to be iring to case is y large I in t.lio rust or i hann- wliieh armless i trent- 'ii.mwdered el wire ; borne 1 in no !d have i mind I like-bowed lisease it was d Unit tosfl lines. nt one rooked large mentone of .j oc. ted :t ver' been iid to .' ] o V" i* up OL e able ra VOL. 216 NO. 4 DANGEROUS DUSTS--HAWES 163 bined resources to defeat them. So much for one found an eighth to a quarter of an inch of brown aspect of this question. desert sand on the floor, some of which, in the Now I return to my subject, "dangerous course of the work, was of necessity breathed dusts." The title is a bit of a misnomer as there in--hence, this man's silicosis. is only one dust that may be dangerous and that Another marked case of silicosis occurred"]u a is the dust which contains silicon in some form. man who had worked for many years in the All the organic dusts and those inorganic dusts, 'Walter Baker Chocolate Factory in Milton, and which do not contain silicon are harmless. L-st yet elio-olale and cocoa dust arc certainly in there be a storm of dissent from those who wish nocuous enough. This man's sole jolt, I found to contradict me when I make this statement, on investigation, was to re>urfaec the granite may I first define the word, "dangerous", ns mill wheels used to grind the cocoa bean. An used here. By "dangerous" I mean a dust that, other very marked and eventually fatal ease of either by itself or in combination with some lirnnchicetaMs occurred in a worker in a large thing else, injures or irritates the lungs or leads lumber mill where every workman was exposed to a fibrous tissue reaction which reduces the to varying amounts of wood dust. In this ease, individual's resistance to tuberculosis and other however, the man fell down a chute into which bacterial diseases of the respiratory tract. Nat sawdust was poured ami was taken out, uncon urally, I do not include chemical poisons. scious. an hour later from the mass of sawdust Let us first consider the organic dusts. Street which had buried him. Here again there is dust, although it may contain small amounts of nothing to prove that wood dust is harmful. silica, in itself is harmless. The only danger in And so I might go on through all the organic curred in breathing street dust comes from the dusts. germs that may be present, especially in winter. Now a word about the non-silicon-containing There has been a great deal of loose writing inorganic dusts. The worker in. the soft coal about the danger of organic dusts, b'or many mine develops anthracosis, which shows up strik years the high mortality among the workers in ingly on an x-ray, but it is not a disabling dis tobacco factories was notorious and was blamed ease, nor does it predispose liim to tuberculosis. on the dust. The truth of the matter is 1 hat If he gets silicosis, ns some of the workers in tobacco dust is not dangerous but that the work the hard coal mines occasionally do, it is be involved in this industry- called for little or no cause of the granite or silicon-containing rock physical exertion and, therefore, invited weak in which the coal is imbedded. I have no doubt lings, while, in addition, the hygiene of the work but that the slate and marble workers will pre ers was notoriously low. Consider the textiles, sent changes in their lungs after years of ex cotton and wool. Anyone going into the sort posure to this dust, but such exposure certain ing room of either a cotton or a woolen mill ly does no harm. Exposure to lime even seems "" wiirusually find the air full of dust. Here the to do good. . bales of raw material arc opened and the con Granted, then,--I feel sure that, many of tents "fluffed up", ns it were. Armfuls of the cot you will not grant it--that the only dangerous ton or wool are then put down an immense chute dust is the one that contains silicon in some form, by the workmen, where it is carried on to the what are the factors that determine the degree next department. In the majority of instances, of danger in the exposure to such siliconanyone entering this room for the first time, un containing dusts? These may be given as fol less he is absolutely nonallergic, will soon notice lows: a tickling of his nose and a strong tendency to rub or scratch that organ and, sooner or later. (1) The amount or `proportion of silica pres _ will experience,some sneezing. Strongly allergic ent in the dust. Silicon is such a eom- persons will have this to a marked degree. Cer mon clement'that it might be said to be tain individuals of this type often come down ubiquitous. It is present in small amounts with a sevenrwciittr rhinitis.or a bmnchitis dur in practically all street dust. The still ing the first 16 days or so of their work in the ness of the fibers in bay, straw and cere sorting room,-which soon. passes off, however, als and that of the feathers of birds is leaving no ill effects. All this does not mean that wool or cotton dust is dangerous in the slightest. And yet one of the most marked eases of silien-:ithat I over saw was in a workman whose job for many years had been in the sorting room of a large factory where woolen carpets were made. due to silicon. It is a normal constituent of lung ash up to 1 per cent. It is only when it is present in excessive amounts, such as in granite dust and sand, which are nearly pure silicon, that it constitutes a menace. A large part of the raw material in this room (2) The form of silicon present, in the dust. came from Egypt or some other foreign sandy Free silicon, SiOj, ns found in granite district. Amazed nt finding silicosis in a wool and sand, is infinitely more dangerous worker when I knew that wool could not he the than combined silicon, ns found in the oauso, I investigated the plant and in this room silicates with one exception--asbestos. 1G4 DA.W.KKi Il'S IH'STS--H.MVIXS N'. K. J. OK M IAN. '.'M. 1!IS7 Kxcrpt I'or aslu-xlns (In' mUi-aIcs may he do not lake the statement of the patient or that described as comparat i wly lumiik'x-;. "I" his friends nr, indeed, of his family physi- (.'misiiliT talc, For iii>lan<-'`. Talr. a nri'a- eiaii entirely for granted, 1ml that, wherever ni'siiiiii silicali'. is die lni'is .a' almost all possible, you yo thrmmh the plant and see for loili't powders ami is ti'i-d > >: 1 11~is rly in yourself the exaet work that the man or woman I Irn rubber industry. ll ratvly. if mom. did and how miwh aetnai dust he or she was lias 1 Ha'll known In rouse a di-aliiimj iloo- exposed to in the eotu'se of said work. This, of -n ill 1 In' IlllliiS. emii'se, does not mean that yon must lake a l.'li Tin1 M.i of dm liu-l 11,1 rl -.vie'. I`a r! ml'-' of less dian 5 mimms are most daimer- dii'l count or make a elmndeal analysis, ulm-li should lie obtained from experts, tnit il does ons. 1'art ivies over that size do not niter mean using one's common sense in sizing up into die liner 1 issues of the lungs and are. therefore, practically inuoenous. The vale tin; situation. The second point to be considered ill milking a diagnosis concerns the sinnploins. of die fibrous reaedon in the lungs j The most, striking of these is shortness of breath ; proportional to the fineness of the dust. cough may be, but often is not, present, while loss of weight ami strength, blond-spitting and (4) rl'lie density o the dust. If the number general weakness arc often conspicuous by their of particles of silicon-containing dust per absence. Shortness of breath hy itself, with cubic foot of air exceeds twenty million out any other condition to explain it. is an im such a dust may be said to be dangerous. portant point. (.">) Intensity of the exposure. The granite Third to be considered arc the physical siyns cutter working with a surfacing machine in the lungs. These, again, may be conspicuously is exposed to infinitely more dust than the absent; but, in well-advanced cases, generalized foundry worker, who is only occasionally du I ness, most marked at the liases and extend in certain types of work exposed to much ing upwards, front and back, harsh, prolonged dust. A survey in Massachusetts showed a and often diminished expiration and occasional silicosis incidence of 15 per cent in gran- fine, high-pitched rales, as if two pieces of ite cutters and only 8 per cent in foundry fine sandpaper were being rubbed together, arc workers. important to bear in mind. In addition to these (f>) [.myth of the exposure. It naturally fol signs there is one on which I am coming to lows that the longer the exposure the place much importance, namely, a marked re greater the inhalation of dust. An .ex striction of chest expansion on taking a deep posure of 12 to 15 years is the average breath. This is especially true in asbestos work time required to give fi granite cutter a ers. I have seen nearly 75 men and women disabling silicosis, while one of 2 to 2 that have been exposed to asbestos dust am! years cjm cause it among asbestos work have found that the one striking sign present ers. in those in whom I have made a positive diag nosis has been a greatly diminished chest expan (7) Finally, and I might call this the most sion, rarely over one inch. One man of nearly important factor of all, we come to that 70 years came in to sec me who had worked indeterminable question, the individual for many years in this particular factory as a resistance to dust. Just as certain persons night watchman and who by the very nature arc extraordinarily resistant to tubercu of his work had been exposed to little or no losis, so arc others, for no known reason, dust. lie had marked arteriosclerosis and con able to breathe in large amounts of a siderable emphysema and complained of short dangerous dust over a long period of ness of breath, but nevertheless he was able to time without damage to their lungs. expand his lungs nearly three inches. X-ray Each one _thc above points must he taken showed normal lungs except for a moderate into account Bcai'ing them in mind, let us now eniphj-scma. consider the- diagnosis of silicosis. This has Finally, wc come to the x-ray. This, in ad been left far too long entirely in the hands vanced cases of granite cutter's silicosis or that of the roentgenologist.. If the x-ray man in court of the sandblaster or indeed in well-marked ns- or at the clinic says that the plate shows a dif bestosis, speaks for itself. The borderline cases, fuse, nodular fibrosis and makes a diagnosis of however, arc very difficult to decide upon, so silicosis, no other faetor pro or con, up to the much so, that I know of no two x-ray men who present time, is apt to be given serious consid would agree. Of course, the presence of a eration. T object strongly to this. complicating tuberculosis, with a history of ex The diagnosis of silicosis, just as the diagno posure to a dangerous dust and even slight signs sis of tuberculosis," depends upon various fac in the lungs physically or by x-ray, would tend tors, the first of these being the history of ex to justify a positive diagnosis, which without posure. Whenever you are called to give an these would be impossible. opinion upon such a case, I would beg that you Asbestosis is a relatively new disease, c-ou- voi NO. I'cr th.-i gu\ 1; i ii ;i i h; - tell. . x ;1 ! hr pur Axb vale its of t fact ly ,1 il In - tioiix regii were hand proei on pi mod *llgg< Sir suhje cure tions or J r ealon sarv ; Xo at of fli 2950 ami the a ultraducin On of sp( sulfat gate In*Kuiniun I'onii bPruidbgliec, fl*unl rahtoUrHii*c*l Astoria rFaotfre ris> VOL. -16 NO. * KVALl'ATIO.V OK CLTllA VIOLET TIIHUAl'V--BL'N'KKU AND ilAUUIS Jg5 ___________________________________________________________________ cerning which wc know remarkably little except cept under prolonged, intense exposure along that it docs not seem to correspond to the laws with a very greatly lowered individual resist governing silicosis in general. There is not the ance. slightest doubt, however, in my mind at least, The points emphasized in this brief talk on that asbestos dust is the most dangerous oE all a very big subject are'the following: dusts. Asbestosis is able to produce total and permanent disability in a remarkably short, length of time, even after only 2 or 3 years'' exposure and occasionally less, as compared with (.1) That there is only one dangerous dust-- that containing silicon in some form; (2) That Ihe diagnosis should he based, not the much slower ami more gradual action r purely on x-ray, but on a history of ex pure silicon and the great majority of silicate'. posure, on the clinical symptoms and on Asbestos is an aluminum or magnesium sili cate or a combination of these or others and. in the signs in the lungs, along with the x-ray; and, its chemical analysis, agrees closely with that (3) That, whouever possible, a personal in of talc, cement and certain other silicates. The spection of the claimant's work should he fact remains, however, that, asbestos is extreme made in order to see for one's sell' jus,. ly dang-rous ami fatal, while tale, cement and lmw milch dust exposure there is, thus iu- other silicates are comparatively innocuous ex I .slicing a correct ami fair decision. PRECISE EVALUATION OF ULTRAVIOLET THERAPY IN EXPERIMENTAL RICKETS'* mv joiin w. m. m.WKKii. i*i!.i>-,t .\.\t> i:*lUitrrr s. hakims, I'n.n.t TX a previous communication, Bunker and llar- handicap of the filter method- is the difficulty of ris1 recorded the opinion that light, radia eliminating longer wave lengths while retain tions of wave lengths other than tlmse in the ing shorter, since increasing absorption is gen region. 2S00-31DD Angstroms, which at that time erally first obtained at shorter wave lengths. Another difficulty lies in the fact that such were generally regarded as constituting a "vital filters do not cut off sharply, but. generally band" of light, may assist in the biochemical allow definite increments of longer or shorter processes of rickets therapy. This opinion, based wave lengths to be present in a selected band, on preliminary qualitative studies, was strength which increments must always he of unknown ened by the findings of Sonne and Ilckling,* who relative'importance,' if in fact there be a differ suggested 2530 to 3025 as an antirachitic region. ence in the. relative effectiveness of various wave Since 1030 but few reports bearing upon this lengths. subject have appeared. lvmulstnF-11 reported By the filter method it was determined that a cure and prevention of rickets in rats by radia hand made up principally of light from two tions from either a quartz mercury vapor arc lines of the mercury arc spectrum, namely, 3025 or from a GH S-l bulb and defined the gram and 3130 angstroms, showed some therapeutic calories of these heterogeneous radiations neces value in experimental rickets in rats. Subse sary to cure u rat whose skin had been depilated. quently, by the use of a water-cell monochrom Xo attempt was made to evaluate dill'erent parts ator. described by Harrison,1 we were able ^to of the spectrum. .Goffer5, reported that, only eliminate from further consideration the line. 2950 to 3100 Angstroms arc active. Knudson 3130, which was completely ineffective at an ap and BenforiF reported in abstract form that plied energy of approximately 1.75 gram calories the anti each itie -effect i veness of monochromatic per rat. ultraviolet ligbt-does not correspond to that pro All the subsequent "work was done with a ducing erythema, but details are lacking. Baiiscli & Bomb quartz monochromator (type Our own study, continuing with optical filters Xo. 33-80-05) with prisms S cm. by 8 cm., which of special glasses, quartz and solution' of nickel sulfate and copper sulfate, enabled ns to investi gate spectral zones of decreasing width. One transmits sufficient energy from a 0 inch. 220 volt Uviare to permit treatment, of rachitic rats with single lines of light. Ki .it;i ill.* I i< u I 10 .*:tt ll I.-ibot aloj pm, Mum In* Ms K.cpn-ininiial Iii'titnie of To hnolotfv. < 'mil i ilitit urn No. T.* from Mo 1 rt im-nt of |Sio|iuy .ml Macs. ofI'ulilir M**alth. Mriys.uhtwttx liiMitutr T-Ui n<'1"U>. I'.nn* IBiiiL.t. John \\\ W.--Dii.vior of lliol.ui. ;il K***'*;u.h l..iU>- The arrangement of the equipment used in the phase of the investigation dealing with moiinclmnnatie radiations is shown in figure 1. t'.iioii**M aiil l'rof.*?*yoi- of rhynioji.|;y nn<( lBi><h*'iniMry. .M.tv- a* hnNi-n.y of ']'<i hnolngy. Iliitiy. Huli.-it --Kixi.ir.h A-S'uri.it.* mi l.t'tlncy, .M.tssai hiis< Us Institute of *[*< lilmli.L't 1 awe 1 MlFor vforJ^ anl nhlv.?*>*-y s -s*'!* "This \Y*L`s In a white Iransite housing. B, open at top and boltoni and raised from the bench on leg', a vertical 0 inch Uviare, A, was placed in the