Document jyKpqpmNyKBnkJN97R45Y3q3O

FILE NAME Talc TALC DATE 1946 Apr DOC TALC115 DOCUMENT DESCRIPTION Medical Journal Article - Pathology of Talc Pneumoconiosis with Report of an Autopsy | Vol April: pp 23-25 1946. Watertown NY y the doctor orried : brought his broken arm n something eeded to set n by mouth it when ob- atility would y inhalation strated one someone to lookers felt killed by the w him come y the doctor it there had Barracks and he intended Ie went out his return he -elated rgical anes leg ed a man of nd surgeon er During -invalid he reux It is 1 by the rexperimentaat the age his daughcets Harbor ity Medical n placed on d the burial I care y night in te highway ed his sor, looked up : other side er husband ing should- eyes above ed in oldd the odor there was t the ghost Pathology of Talc Pneumoconiosis with Report of an Autopsy F. W. PORRO M.D. Watertown N.Y. and N. M. LEVINE M.D. Ogdensburg N.Y. NEUMOCONIOSIS is the general term Papp NEUMOCNIOS NEUMOCNIOSI applied to the effects of inhaled dust on the lungs Only in recent years have most of the known important facts about this group of conditions been established by observations and experimental work Some forms of pneumoconiosis such as anthracosis due to the inhalation of coal dust and siderosis due to the inhalation of iron ore dust are generally considered to be relatively harmless Silicosis from the inhalation of dust containing much un- combined silicon dioxide free silica and asbestosis due to the inhalation of dust from the fibrous silicate asbestos are gen- erally recognized as serious forms of pneumoconiosis capable of causing pulmonary Abrosis and consequent disability Silicosis was established as a disease entity about the beginning of this century and asbestosis rather more recently in 1924 by Cooke The various aspects of silicosis and asbestosis have considered in detail by Lanza et al A brief consideration is given by Gardner Among other types of dust that have received recent attention in connection with the production of pneumoconiosis is tale which is mined and milled in St. Lawrence County N.Y. as well as several other parts of the United States Reports of the working conditions and effects in this area have been made by Dreesen 2 and by Siegal Smith and Greenburg 11 Porro Patton and Hobbs 10 have re- ported clinical and roentgenographic findings on fourteen cases of pneumoconiosis in tale workers including autopsy findings on Ave of the cases In addition observa- tions on the tale industry in Georgia have been 3 cases reported by Dreesen and Dalla All of these observers have found with increased pulmonary densities and with disability in advanced cases general The pathologic findings in the lungs of tale workers consist grossly of a fibrous stiffening of the lungs and often old fibrous pleural adhesions Microscopi- cally there are found asbestosis bodies and pigment laden macrophages in the alveoli and respiratory broncioles In addition there is thickening in many alveolar walls and septa with the reaction consisting of histiocytes fibroblasts loosely arranged collagen fibers scar tissue and a few lymphocytes as well as some amorphous pigment There is hyperplasia of the lymph nodules along the septa In the alveoli poorly formed giant cells are sometimes present There are also varying degrees of atalectasis compensatory emphy sema and sometimes metaplasie of alveolar epithelium into a layer of cuboidal cells in fibrotic areas In addition there is some times complicating silicosis tuberculosis or other pulmonary disease These findings are similar in nature to those described in asbestosis by Gloyne 7 and others The asbestosis bodies are the most specific finding These are brown beaded and dumbell shaped rods in length usually several times the diameter of a leukocyte They have been shown to be composed of a thin silicate fiber which is covered by brown pigment which contains iron probably hemosiderin They were originally noted in the lungs of asbestos workers and were first observed in the lungs of a tale worker by Gardner from a case observed clinically by Patton 9 and autopsied by Free Tale is made from several silicates of similar chemical composition to asbestos and some of which are fibrous although not so much so as the minerals from which asbestos is made These bodies have been found in no other conditions The following case with autopsy is the first available in a tale worker since those previously reported 10 and is of interest due to the similar pulmonary findings - History J. R. age 46 male white a tale miner for 14 years He entered the A. Barton Hepburn Ilospital Ogdensburg 24 NORTHERN NEW YORK MEDICAL JOURNAL General View of Lung X300 showing rod shaped asbestosis bodies and macrophages in the air spaces and a fibrocellular reaction in the interstitial tissue N.Y. Sept. 7 1945 under the care of Dr. J. R. Patton He had been unable to work for three years because of difficulty in breathing Two weeks before he started to expectorate bloody sputum and complain of pain in the left side of the chest ray findings revealed the left lung field below the level of the first interspace to be completely obscured and in the right lung field a dense reticulation The dyspnea con- tinued to be severe and the patient expired on Oct. 30 1945 Gross Autopsy Findings The body is that of a white fairly well nourished well developed male 46 years of age There is cyanosis of the finger tips and slight hypostatic lividity and fully developed rigor mortis The legs are edematous up to the portion The abdominal panniculus adiposus is yellow and moderate in amount The peri- toneal cavity contains A considerable amount of serous fluid The liver is three fingers below the costal margin and on section shows a pronounced nutmeg appearance The spleen is large and soft with prominent Malphigian corpuscles The pancreas and gastrointestinal tract contain no gross lesions The kidneys are congested and the medulla of the adrenals is soft from autolysis The bladder and prostate are normal Both pleural cavities are partially obliterated by fibrous and fibrinous adhesions A small amount of cloudy fluid is present on the left side The pericardial sac con- tains a small amount of serous fluid The lungs are firmer than normal yellowish as in chronic passive congestion and have areas of firm triangular bluish dis coloration On section these are hem- orrhagic and the lung cuts more firmly than normal Old infar are present The left auricl trophied and there of the left ventric shows some sclerc is marked stenosis permits a small f slight arterioscle valve Microscopic Fir of the myocardiur are present In the liver the lar congestion and One section of hemorrhagic infa many alveoli cont and macrophages Some of the bodies Localize tasis is present septa and some ened by a fibroce histiocytes scat blasts collagen f pigment No tu are found Pathologic Di carditis and end sis pneumoconi chronic passive hemorrhagic in passive congesti and lower extre C The lung find of a moderately osis similar to such cases comi there are many are the same as in pneumoconio bers here in p pneumoconiosis pneumoconiosis A photograp reaction and a spaces is shown The fibrosis sidered to be | fection especia greatly increas but there is n pulmonary infl d macrophages a considerable The liver is three margin and on d nutmeg appearge and soft with corpuscles The inal tract contain kidneys are conf the adrenals is he bladder and are partially obrinous adhesions > fluid is present ricardial sac conrous fluid han normal yele congestion and gular bluish disthese are hemmore firmly than ___ NORTHERN NEW YORK MEDICAL JOURNAL 25 normal Old infarctions up to 5 cm across are present The left auricle is dilated and hypertrophied and there is a similar hypertrophy of the left ventricle Section of the heart shows some sclerosis of the vessels There is marked stenosis of the mitral valve which permits a small finger to enter There is slight arteriosclerosis about the aortic valve Microscopic Findings There is scarring of the myocardium and some Aschoff bodies are present In the liver there is marked central lobular congestion and necrosis One section of lung consists largely of hemorrhagic infarct Other sections reveal many alveoli containing fluid erythrocytes and macrophages containing hemosiderin Some of the alveoli contain asbestos bodies Localized emphysema and atalec- tasis is present septa and some Many of the interlobular alveolar walls are thick- ened by a fibrocelluar reaction consisting of histiocytes scattered lymphocytes fibro- blasts collagen fibers and amorhous brown pigment No Lubercles or silicotic nodules are found Pathologic Diagnosis Rheumatic myocarditis and endocarditis with mitral steno- sis pneumoconiosis tale with fibrosis chronic passive congestion of the lungs hemorrhagic infarcts of lungs chronic passive congestion of lungs liver viscera and lower extremities ascites DISCUSSION The lung findings in this case are those of a moderately advanced tale pneumoconiosis similar to the findings in all previous such cases coming to autopsy In addition there are many heart failure cells These are the same as the dust laden macrophages in pneumoconiosis but are in greater numbers here in proportion to the amount of pneumoconiosis A photograph showing the fibrocellular reaction and asbestosis bodies in the air spaces is shown The fibrosis present in this case is con- sidered to be due to pneumoconiosis Infection especially tuberculosis may cause greatly increased fibrosis in pneumoconiosis but there is no evidence of this or other pulmonary infection in this case The heart disease is the principal disease However in pneumoconiosis with fibrosis disability may occur from the fibrous alone with the principal symptom being dyspnea which is caused by the destruction of lung tissue and perivascular fibrosis SUMMARY 1. The general aspects of pneumoconiosis and the pathology of tale pneumoconiosis are considered 2. A case report including autopsy findings in tale pneumoconiosis is reported 3. The findings in this case are similar in general nature to those previously reported and are similar to those reported in asbestosis a REFERENCES 1. Cooke W. E. Fibrosis of the lungs due to the inhalation of asbestos dust Brit M. J. 1924 2 147 2. Dreesen W. C. Effects of certain silicate dusts on the lung J. Indust Hyg 1933 15 66-78 Dreesen W. C. and Dalla J. M. Effects of the exposure to dust in two Georgia tale mills and mines Pub Health Rep 1935 50 131-143 Free J. E. Personal Communication Gardner I. U. Personal Communica- tion 6. Gardner L. U. The pathology and roentgenographic manifestations of pneumoconiosis J. A. M. A. Feb. 17 1940 114 535 7. Gloyne S. R. in Lanza et al Silicosis and Asbestosis Oxford University Press New York 1938 8. Lanza A. J. Editor Silicosis and Asbestosis Oxford University Press New York 1938 9. Patton J. R. Personal Communication 10. Porro F. W. Patton J. R. and Hol bs A. A. Jr. Pneumoconiosis in the tale industry Am J. Roentgenol & Rad Therapy 1942 47 507-524 11. Siegal W. Smith A. R. and Green- burg L. The dust hazard in temolite tale mining Including roengenological findings in tale workers Am J. Roengenol & Rad Therapy 1943 49 11-29