Document jBpQ37eL8b0j6Lyg320x1MpQy

FILE NAME: Abex (ABX) DATE: 1949 DOC#: ABX260 DOCUMENT DESCRIPTION: Journal Article - The Pneumoconioses HrptUttrA /Il t h e (Mirmii uf tin.!/# i , #. IVI. i l , w I t Vl V. f*r .iM M M fil VUV9t: ni finn f ilili infuni THE PNEUMONOCONIOSES Which Intluilnal Duiti Al Incil? Which Aie Hoimliil? Why? L. I . KAMI IN. H O ChHnue Tilt- trilli im-niiuiiiuitiiiiu.ii li.m lirrn mi litusi-ly .-)i(tlit-i1 in inilic.l ricci |iulmmiut v cmulitiuus timi mhiu* rl.Hilii'.'itinil ;i| i|hmis In lir ilrnualiti'. fi m in alliinln-.iVL- t.i|ilinll lui il v,Il Ili)' ni |iiitiiiuii;ii y .ili n i uni-. n*Millili|; rioni tliL* ilItl.il.it ii ni ut u n ii tu li:iin (di iIiit.1. I itiiii Muli)' il ili--imi imjily 111cilisi-. Imi .'linijily "ilim in llie luuiiu. il ime in In arivjit iIiim iiu-miiii|;, llicretini', lUiciiiiiimiH iiiiiuMn must uh link- :iuy triniti imi ut limi in lite limnb, lielliur ut mlimliinl uii|;in ut nut ami wlicllier ut lii.siu. il rii.mi. |ii ulilri.iln/L- ur neri tinn. Il illuni almi iiicliiilu liti' umili aulii iu |>i|;uiciiIalimi trulli limi, cari imi imi niiiukc nliiuli 11 noi mal lun^s cnliiliil ; in lite iutcrin ulalimi ni |initii>lii|>ii; uliaiijju. lite mailer ut iteyreu as vieti ai. n)H-riiiuity numi Ire unnniilcieil. l'rmil a [tradirai niaiiil|uiiiil, Imncvci, |iiiuitiii<mu cmiinsis iefers uiaittly tu jniliiimiary alterai imts all i Ulu lai ile In Illune ilunt.s cuculiulcidl r iiiiliistry ivliiuli ';m ratine jirutiterativc reucl iuii.s, n il^nmlu[;L |iu!lrmn lui* tu railin|Kii|UL' |iru|ierlicn ur i|ilc c'aujjrrutiiin ut imi mal linear iunrkiu|;n. Tlir.n li.ui|;t-n ire rutiirly (listim i tinn tilt- ai timi ut Invi' i-.tn, ma li ni. k'.ul ni uieiciiry. liir tvliicli Ilio liui|;n a lui'irly ;m tilt; |iiuti( ut entry itilo lite limly. Tlir) .liliri liso frinii tlie traciiuus |irniiui'ril liy inyculir a I ullii'i urlami; cliints, ns u'ill lie e.v|>laiiiLil. ra ti ii a {int tiirciitix ul lite S r n u IVtritc ticallb and il Strillili uh UmetAl A iuiual S o lfa ti u l lite A m n ic tu M cd io l . tu l'if u riilitit M edicine a m i Jttwr al Ib t N in c tr'& tv u itb rtoujltuii. i*bica|n, 2J ( ----- Industrial dusts are listed liy K miteiihcrg and Morse ' as follows : I. Organic Hints: A. NunliviuK : I. Toxic awl/iir inilanl It. laving: 1. Macinini 2. lingnlis II. Imirgamc Ilusts : A. Toxic atiil/m titani II. Fibrosi* imnlticiiig C. Nimfitinisis |iuliidni: riassificalittii ul industrial dusts into "liarmfur' and "inert" categories is nut easy Iteratisi: some svilirli are usually ronsidrieil iiuinrnnus ntay produce defunte jtalliolojjic <-ti:iuges under certaiu riniilitiuiis. Mieli as ptulntiged cKirs'.ivr espusine. In the following illudili' i.tliiiii ul S andri'-.1 giuiiping, reitaill dusts are drsig* iiated as liaimliil even IItimeli they du lint pindure lilil oils |iiifiixiii.ti v tdlnaltnus. (h |;au ir dir.!'. tnisr inaliliy Irtnii allunai nr vegetatile materials. Imi iti.niv ale synlhetir. They du nut lansr imliiliiitary Idiin-is Imi aie rapatile ul producing lural in tatuili svilirli lesults in surli things as dermal itis. dental lesions, in talinit ul the mucous iiieuiluaiies and rtmjimclmlis. S:i|i|iiii|:t<iu J litis listed mure than ime luuulred oci:ii|t:iliiius in svilirli these symptoms and/or allergic manifestations may lie firtKlticcil frulli sulislances lihe |inllens. horse hair, furs, wool and wood Itisi. Ilyssinosis, an occupational conciti imi resulting front dust encountered in the riiltnn imlitstry, has lieeti rc|mrlcd in Kurupe as ;t definite occupational disrasr, lint its cxistrnre ns a clinical entity in this country is ipteslinnahlc. Ai ute symptoms and roenlgenolngir find ings suggestive id piieiiuiiuiia id the iiillueur.al type have followed exposme to an nrganie dust produced hy crushing or shredding litigasse, a waste product ofI. I . K rn n co !irt|| M , am i Muim*. K . M .: llr a lllt l U t u tt li o f (l(c it|ts liu ta i E itv lio n n in tt. I 'l t m l a i IS<. 5 |ttin if ir ltl, 111 Illinois S ta le H r|ta it mm 1 l lr a llh . t . S a n d e r. O, A : T h e l*iirmniM*iwtittcaa |iriin riat u*i*iMMiiir<iiliin In lltr author, N aa. H . MUI J . S a p p ln g to o . L I t . : h iirn lM l ul I m l u il ti i l I Scalili. I*luli<trl|t|ii, J It IJpitlncitil I 'um ii.itit, lHJ, (>[ IJ16187. nt M :.-S H i o -M 58 sl3 o" P32" E. 5 H ir a m or Fottotltlly H inoiul fca~a a g-Su ls 1^ sH -'S^n? tri oSu5ign5ft^ nw0< i< i3 5y t S:im13 mS%! caa t o B3 *& Cj -WCM Tt a s l l & al 2" " B 52 --MtS a a ti <4HU5 s e | s& si ^ o I 5Q U 9* B8SS&n " 2 Sc3H e " .< Aa.Un o X aa * ISIi 3f 3 .9 s? 8 10 S - s ; *in u i: a un-- o? - S P " 3 D B Cfl 3 s <i i i - I . s a m I g t . : 9 a S " s g s s s i i S s f 9 a filai s lg aSflS S p IS tp S y S c S a oa ft* 535fiuiiSDOTSmfi3'jan33l51Slu OSH -4 a-i I sugar cane. The condition is described us lingassusis and; like hyssiiiusts, may lie due lo an allergic reaction rather than In actual |ialhiigeuic |>rti|ieriies <d the dust itself. There is alsti simie rcccul evidence to show that hngusstisis may lie caused hy a fungus or tinssilily hy bacteria attached In the dust and that the dust itself is rclalivcty imionintis.* C. I1'. Long * invest gated more than 1,2*17 workers in the loliaeco'industry and ennchidcil that luliacusis dues nut develop in the lungs uf those who inhale tuhacco dust. Recent studies, however, liy McCurutick, Smith and M arsh" indicated that there may lie a significant free silica hazard in the stemming and reilrying operations in that industry. I'tihininary diseases caused hy ftinguiis iufretinns have been receiving more attention in lecetd years. Increasing rcciigiiitioii id these cases has teil many dliservcrs to lielieve that they may lie more prevalent than is generally supposed. Mycotic diseases are usually luiuiiulusliial and are found only in eeitaiu geographic locations. Nevertheless some cases have iiffti alttiluiU'il to oiTiipatioual exposure, hi 1*) 15 tie ' reported a ease of linmclmpuhttouai y asper gillosis, ucciirring in an employee of the Chicagn Slock Yards, fur which an award of t'iiiii|K-iisaluiii ns granted and upheld by the Industrial 'nniiiiissinii of Illinois. Fungi are rdumrulutis plants of simple structure, among them lieing various yeasts aud molds. They may attack the lungs ur other parts of the Iniily aud give rise to such conditions as moniliasis, aspergillosis, sporotrichosis and coccidioidomycosis. It is impmlaot for one to hear this fact in mind, particularly when reviewing the industrial roentgenogram uf the chest. Tile pulmuunry shadows produced hy yeasts and molds may easily lie confused with those caused hy free silica unless careful consideration is given lo the patient's occupational history and exposure In dust. In recent years coiisidcrahle research has liccu done on multiple pulmiiiiary rnlrificnlum. This condition*S7 4. (citt Il ; T .ig tt, M , ,it>.l M aitnnu. N. A .. l*aflMumi`iii 1 Ih g M iy, A rd i, l'ztlft. I 1 1 .t-M M*l < O r O 1947. S l.tMt*. (* l*\: 'lulittru liu ti Miti lltf llititun l.imo, Intinti Mrl 8 t J 6 i Jl.9 (S c ili I l*MV A. McCotmitk, W, K ; Stilili. M ami Mavth. S P .i Ilraftli tlaiarli al ihr Tobaccn StitutniitK ani) Itctli/uia Im iu tlrr. i liulutl. II) . A Tuaicat. 3 0 1 4 3 51 (JarU 19411, 7 Tue. ti. C .t I r iw n r Ilrrnit-lHiftitlmoiur/ AifHtitiltnui, an U ro liti Im u I llitcate. Ann lu i U n i. 2 3 x 4 iJ> 4 2 5 (Sr|tt.) 1945. CORRECTION: flaragraph o t t o p o r f u g a 5, Linos 7 and B, I t now aoema r e a s o n a b l y c e r t a i n t h a t th ey are oguaod by th e fungus Histoplnsmn should ba trore a c c u r a te ly s-B-:d a s f o llo w s : *T hose c a l c i f i c a t i o n s 0"=- o f t e n a s s o c i a t e d w i t h s k i n s e n s i t i v i t y to antigen derived from th is fungus". n^ baen shown o o n c lu s iv o ly t h a t istopiasTna capsulation i s thu nctual causa ol th e se pulmonary c u l o i f i c n t i o n s . IMMllll M |k I ti M . . . . . i j ................. |m!iij|iiii|; Il irsi! im im lr Muli sulislam es a-. i Illum inili ami ili rmiipimmls, ladulim ii ami aisi-mc W ln lr il is rri'tioni/fil tliat lite c ita i majiiiily ni iiiilnslii.il ilusls are in n i, ;is far as causine ilis:ililni|; Itluic.e. is <ni n i n n i , ime slimilil mit liirgel Miai ic ila iit u llin siili slaucrs rati |irinim e tinsi ni Innirs tvlmii m.i)' i anse scrinila illurss. T lirsc a ie Ilio hravj' ilici.ila, sitili as Irail. m rrrury ami manganese. As pim ilril itti! r a ilir i, Musi ur lim irs ritmi tiiriu iln uni cause sii m in ia i Imi;; rilancili Imi mcrely use Mie limgs as a |m il.il uf e n liy iutii (Ile limly. In lalcr y ra is sriiim s lu s ir elici Is li.ive Iiitii altriluilcil hi licrylliiim ami ils einii|iiiiimls ami In [imics aiising frani Mie fusine "I hnuxile in lite ui.iiiu- factiuc ni aitilieial aliiasivcs. T lirsc ltn i iim hliuus havr irsiilicil in severe (mriumitiilis ivilti ilelinite incili CCiiiiliicie limluics ami suine ialalilies. T h e ex m i elnlncy lias imi yel lieen liriciinitiril ili eilliei. ami il is i|iicslumilile n lu 'llirr lliey slumlil he elassilieil as jmen- iiiiiiiiH-iiiiiuse.s tintiI ihcii slaltis lias lieen m ure a c n i lalely ileniiiustialeil. Wlicn iiilialcil uvei liitig |icrimls ni lime ceilaiii ilusls may limi line sli.ulims in Mie niriitj;rim |:ram u iiiiit elusely icscmlile Illuse uf silm isis, v i Miai ime slumlil resisi Mie leiii|ilnli<m tu make a iliacmisis uf u n ii |ialiuual ilisease un th ruculernuliigir faiiur alitile. 0 Some physicians have hatt (he embarrassing experience of making a "long distance" diagnosis solely from the roentgenogram, only to find out later that the person concerned had worked in an office all Ids life without ever having been subjected to dangerous dust. liven when the roentgenologic evidence is associated with a history of employincut in a dusty industry, care should he exercised hy tile examiner to make sure that the occupation offers adequate exposure to dangerous-sized particles u( material capable of causing actual damage to pulmonary tissue. It is still a common practice among physicians and roentgenologists who have insuf ficient knowledge u{ industrial environments cir modern hygienic practices to arrive at premature and inaccurate ciiiiclusions simply because they have based their iulerprelaliiiiis (hi too little information. Unfortunately they MHiii-iiuies rsprrss very dogmatic opinions without 0 | |-im|; |i. ii'.iilri the rlfrct on the ruiphiyi-i or the *ki i Iit11 t ll I hr ili .lti' Mii|: I1 .1I11I1-. ii| llu:, riiuihii'l a ir lli.il i nt|>li.%-!-. liitMinr oerdlrs-.lv al.uiurd. forsake thru lilelinii- vin.ilnms. sollri lin.iiicial loss anil lulled seniority. Inihisliy is di'pim'il ul Ilit- services uf skilled winkiurii. L'liiifronls linen rd |iinilinliim and faces unjust and costly liligaliini--all because of unwarranted roentgeno logic interpretation and mi familiarity of the examiner with progressive industrial medicine ami hygiene. The number o( unrelated conditions capable of pro ducing roenlgenographic shadows in the lungs simu lating silicosis is constantly increasing. In 1946 I listed some 23 of these, which ranged all the way from cer tain cardiac afflictions to exaggerated linear markings representing ]nilniuunry vascular changes due to advancing age. Gardner* and others have demonstrated that silicosis is likely to develop only when significant concent rations of respirable-sized particles (those smaller than 10 microns, and especially those smaller than 3 microns) of free or unconihined silica have been inhaled over long periods o[ time (2 to 25 years, with an average ol 10 years). This fad emphasizes the need for careful appraisal of injurious contamination by dust in the 8 . G a rd n e r, 1. l i . : Pathology o f S i lw n li i In K imcU c. B. E *; Second Sjinpuslum on SIIItM ii, Wausau W li., Em ployer* M utual*, 1935. 7 actual working places and correlatimi ol this appraisal willi the occupational history, clinical and inentgeimlogic findings when one is evaluating my case til sus pected occupational fibrosis. The must important consideration in any such investigai imi is, " I low is the man hiiusell affected ?" Altliuiigh the amount of visible dust in lite atmosphere ai numi a specific job appears to he great, that hid does lint necessarily mean Ilia! pathologic rpiantities id the particles are reaching the alveoli of the lungs. Accumulaiiims at the breath ing level and the defensive mechanism id the n|i|H:r ruspiran ny tra d must lie lakeu mio accollili along willi the length and constancy of exposure. 'I'tie absence of pathologic change in the piesencc of the ilici t dusts may lie explained m pail by several factors. The ualttial hariicr In dust provided by tile anatomic aiiaugeiiieut of (lie tippri iespi la liny liart, the cilinlril epithelium of the mumm. mriuln.im- filling the Inouclii down to the tcimimi! Inmu linile'. and the piiugnr) lie cells in the alveoli alt selve to eliuiinate inhaled dust. When line cmisideis a ptilunniuty velili tatiun late of suine IK culiic feel per Ilnur, ivliich may inervuse firmi 50 tu Kfl culiic teel per hour mi cseuioii. it is lint (lillicillt to sec Ilow well tills drlciisivr media iiism of the body works. The long period irip n m l for the development of rccngiiizidilc silicosis, even under heavy exposure, attests the ctlicieucy of the arrangement. T he size of the particles uf the uliending dust is also an important consideration. To he inhaled, dust must he air borne and also must he small enough to reach the alveoli. The diameter of an alveolus is approxi mately 250 microns, hut, as pointed out previously, experience has deiuonslrated that very few particles of mure than 10 microns in size ever reach them, certainly ml enough lu produce damage. And, as was also staled before, th inert dusts do not appear to have a chemical reaction nil lung tissue, such as silica does. This faclur is perhaps one uf the must important teasuns why these dusts tin not cause fibrosis It may lie said that up to the pir.si-ul lime only (tec silica and asbestos have been believed capatile of caus ing definite pulmonary fibrosis, and the reaction in each instance is quite different. Must uf the other piieumtmo- B conioses exhibit a characteristic tissue response. Accurd big tu Gardner* the roeiilgcuographic appearance in tiiese cases consists of a mere accentuation of the nor mal, brandling, treelike shadows, cast chiefly by the blood vessels. It represents a simple linear fibrosis ami is difficult to distinguish from the mild accentuation of T a s l e 2.-- Classificatimi of /'iib n v iia ry Comtilions. Hiicntycnugrams of If'hich S'imiilolr That* of Silicosis A. Pram lailuilrU t D uiti 1, Organic U l Uyailnaili (li) llHgauoftln IO T atiitoili II. IflurKinle lln rrll ( t ) Allllitactikli 0) lluillo|tat|iie DrimalU lUrliim ((Itrilutta) If till (tiliirfU fliJ Ttu * (TiiilO (r) Ifrartlun In llrrgllhmi ( I'mllfi r a l h r ) (ill A iliritifili 0. Primi KuiiliiilMilrlitl liuala I. Iljru llr (trahl* Mnt IIiiMp) {) Ab|irri;IUiiKlB tli) MtmUlaal* 1r| Wain! limit a p a rt Infettim i |il) CttrrMMtluiifyeaalt t((r)| IAllralMlnnuiiuiitfrruuitllal II. M M lin ru in (I llllla rr (u h rm itiiilr (it) tinrm lilufli (rl Mllfnt Klmuala tit) C iiirrn fiurlaalaar) (e) Valvular rh a a g n (I) lllllirir f t l d t o t l i (*, u lirtrji>") (K) Efjrlltm tila (li) llrimthlnlltla linear markings sometimes seen in roentgenograms of persons with nil known history of exposure to dust. Me designated ibis cITect as "benign nnuspecific pueiillionoconiosis," and it includes every ktiotvu reaction to mineral dust except that to soluble |misoiis, sudi as lead; the specific diseases silicosis and aslicstnsis. and certain "roentgenologic conditions," such as haritosis, stannosis ami the pseiidonoilulatiou of arc welders. V (atdncr. 1. tl ; The J*llnttngg ami Rucntarmiitrliiliir M m iltiU limit of riwim acimiwla, J. A hi. A. I M t S i S S U <Fcb. 17) 19(0. 0 Numerous observers have pointed uni lliat deposition ot incil trim oxide into the lungs h inn orrupnlinns like welding, Imriihig, polishing ami rinilinjj has resulted in pigmentation of Ilie jiiilnioii.ii)' tissue, which gives 1ise to discrete nodular shadows closely reselit11111111 those |innluceil by (ire silica. Postmortem examinations of several patients with these signs have shown no evideuee of Ila- typical iimhitai lilnn-.is of silicosis. 1'or the past two and a hall years. Iieeaose id metiigeiiulugic findings s u r e s t ive n( silicosis in the roentgenograms of the ctiesl of some Immers and grinders, my associates ami I have lieeo conducting csperiiuenlal work at the Saranac l.aliniatoiy, in wliicli studies aniniafs have lieen exposed to irpifscnlnlivr coliceol rat inns of air-home dost fnnn gt iuding uprialions. Analysis ot this dust slums ii-l.ilively low amounts of free silica Inil very high ijiMiilitir* ol non oxide pai tides. Animals killed thus iar drnnm stiatr no ptiloioiiaiy lead ion except that compai.ilile to reai lions fiom other inert dusts. The ivuiU is nmluiimtg, and restdls will lie published when siillii irnt tune has elapsed to produce valid conclusions. ( tthei iueii dusts, like those derived fioin till ami hniiom, are capable ol causing changes tit the rculgemilu|;ie pallet n wliich, although very evident in the /dm, are iiondisaliliiig am! do nut result ill fihrusis. They are very impoilant. however, from the standpoint of diagnosis. It has long been recognized that silica, or silicon dioxide (S it),), which makes up (ill per cent uf the rucks ami minerals of the earth's m ist, is the speci/ic cause of silicosis. It exists cither ill the free state or in comliinatiim with cerium mineral oxides to hum silicates, such as mica, clay ami feldspar. Tims Iar only free silica is known lo piodncc silicotic lilnnsis of the lungs. The term lice silica usually means ipiail/, of which there are many varieties. Then- me other forms id free silica, as shown in l.ililc J. It has nut been demons!lalcd authentically (bat sili cates nlbcr Ilian nsheslos pmdtiee real pulmonary fibrosis. I'lilmuuary changes due to dusts cuiilaiuing them have been reported, lint they probably resulted from small amounts of free silica, which existed as 1(1 impurities. However, more investigation is necessary before one can make definite assertions about the innocuous diameter of these silicates. Industrial |iultmmary disease offers a real challenge to the general practitioner as well as the industrial physician. As the family doctor he may lie called un to express his opinion as to whether changes observed in the roentgenogram of the chest are causer! by occu pation or not. F.vcn though lie is not directly associ- Ta ii.e 3.--Forms of Free Silica, Causing Silicosis, Classic and Modified Uriilktlloe (L'rnUNliit ttruelutej O m totiillle T tklrm fle * QuarU flfW torrrfttsllln (4!r}>i!a| ric o ttu re to o lloa to lie c a illr lUtlhKiliolittl) O lirireilu u f * Filai * Ulicrt Jaaiw r * Tripoli Amorplwvi (HuarifiUttliie) * Dlatomlt * Olllea Get * V lltvuut Ulllra Opri * T h e campouailfl markrtf till a n ailerlak a ta llto u o f th e v rt-atrri InUuilrlal Importance. ated with industry, most manufacturing concerns will welcome his interest and be more than willing to afford au opportunity for visits to the plant so that he can obtain first hand knowledge of actual working condi tions. Through such contacts he will find that his appraisal of industrial diseases will lie greatly enhanced, and the experience will prove to be fascinating and surprisingly valuable. 2501 Blue Island Avenue (B). Printed and VabUthrit in the United State* of A m rtim