Document mp8LmNZnqyd1znX0eEmv8JEQQ

FILE NAME: Saranac 7th Symposium (SSY) DATE: 1952 DOC#: SSY009 DOCUMENT DESCRIPTION: Transcript of Presentation by Dr. Vorwald with Discussion T i n s n o t Pics 77. ggBJICTt tHX IKKALATIOH OF CSKEAI* IKDCSTHI1L SUBS7AJK3S Chairman* Theodore 7* B atch Monday, 8ept 22. 2* - 5*30 P . K. B rief f ir r lm Silica T h o m * K. Dorfcaa iibsto irtfanr J. Vorwald, M. D. Baryllioa Bauxite Ciscoes!okl. Harriot L. Hardy* H. D. C. 6. Shaver, M. D. wl Donald Solandt, H. D. 3s* Synthetic Silica Philip C. Pratt, M. D. fit* Tate of Tnfralod Particulate* Discussion, lod by Marrll gjaenbod Theodora f. Hatch _______________________________________________________________ Z8*__ W e're b eh in d sch ed u le, so I th in k ve should b e g in . We h e r e a v e r y i n t e r e s t i n g a fte rn o o n * We d o n 't r e a l l y w is h t o r u n o v e rtim e a s we d id t h i s m orning* I hope a l l o f you h a r e fo u n d food* The C h ie f o f P o li c e c e l l e d me up end t o l d I me t h a t th e r e were a number o f o a r s p a rk e d a b o u t w ith o u t j i h a rin g p a id t h e i r n ic k e ls , b u t y e t they do n o t have th e re d i t a g on t h e i r w in d s h ie ld s * A g a in , we u rg e t h a t you r e g i s t e r ! a t th e John B la c k Boom and r e o e iv e y o u r a u to m o b ile c a r d s , o t h e r w i s e , y -a may f i n d y o u r s e l f e lse w h e re o t h e r th a n i n th e Symposium* Our to p ics fo r th is aftern o o n ooncern various J s u b s ta n c e s an d we have s e l e c t e d a Chairm an whomwe b e l i e v e I i s o u ts ta n d in g as a m oderator o f th o se to p ic s , Poo to r B atch from th e School o f Public H ealth , the U n iv ersity o f P itts * burgh and th e In d u s tr ia l Hygiene Foundation o f the H ell on In s titu te in Pittsburgh* D octor Batch* He w i l l s e rv e a s th e C hairm an* * BY DOCTOR BATCH! D octor V orvald and the Synyoeiunt I t o ccurred to! me a s I was l i s t e n i n g t o th e p ro g ram t h i s m o rn in g , th e d i s - ' i c u s s io n o f th e v a r io u s v ie w s, t h a t some o f th e d i f f e r e n c e s j 1 t h a t w ere made e v ld o n t by the d is c u s s io n atom from the f a c t! th a t we, as a group, do n o t hi.ve as com plete an u n d e rsta n d -: i | j in g a s we w ould l i k e t o have o f th e mechanism o f - o f th e | __ v a r io u s d u s t s , and t h a t as we g a in in o u r u n d e rs ta n d in g of _^ ] ; ....___________ ____________ ___ ___ ______ ____________________79m . . i the b a s ic mechanisms o f a c tio n , the problem o f d e fin in g the! th in g t h a t w e 're ta lk in g ab o u t may become e a s i e r , a n d i t j w ould seem t o me t h a t o u r a f te r n o o n s e s s i o n , t h e r e f o r e , j should c o n trib u te in a very viseful way, to easin g th a t j | d if f ic u lty as i t appeared in the m orning d isc u ssio n , j ! Ve h a r e , a s you a l l s e e , a s e r i e s o f t a l k s on The I n h a l a t i o n o f C e r t a i n I n d u s t r i a l S u b s ta n o e s , b e g in n in g w ith th e o l d one o f s i l i c a and g o in g th ro u g h to some o f th e j newer m a t e r i a l s and some o f th e new er oone o p ts w ith re g a r d to the a c tio n of dust in the lu n g , I u n d e rs ta n d t h a t some o f th e p e o p le i n th e b a c k of th e room th is m orning had d i f f i c u l t y in h s a rin g the arious s p e a k e r s , so t h a t I w i l l now a sk th e s p e a k e rs t h i s aftern o o n to keep th e ir T oiees u p , keep tk a t in m ind, and to make su re th a t th e y speak up lo u d ly , j I was p ro v id ed by D octor Vorwald w ith a program | in advance, in which he has c a r e f u lly n oted the number o f j m in u te s a llo w e d f o r e a c h s p e a k e r . S in c e we a re a l i t t l e j J l l a t e i n s t a r t i n g , I afc ll pound th e b e l l down h e re v e ry | | p ro m p tly to make s u re t h a t th ey s ta y w ith in t h e i r tim e , j ! The f i r s t s u b j e c t t h i s a f te r n o o n , u n d er t h i a g e n - I| , o ra l heading of in h a la tio n of c e r ta in In d u stra Jl substances,! i is a d is c u s s io n by Mr, Durkan o f th e L aboratory S ta f f on : * S il ic a , I'm sure H r, Durkan needs no f u r th e r in tro d u c tio n ; ! than th a t to u s. H r. Durkan. BY MR* PURBUH i K r. C h airm an , Members o f th e Symposiums } (D octor Durkan re a d h is p rep ared p a p er, w hich is i on f i l e a t th e L a b o ra to ry )* ! i BY DOCTOR HATCHs In view o f the f a c t th a t our se v e ra l su b je c ts in i th is to p ic a re e x p re ssed in s e v e ra l p a p e rs, i t would be b e s t to p e rh a p s l i m i t discv g sio n and comments to th e end o f th e p r e s e n t a t i o n , so I c a l l n e x t on D o c to r V o rv a ld who w ill duscuss the fin d in g s in re fe re n ce to asbestos* ! BY DOCTOR VORWALDt 1 I t 'o n o t easy to cover the to p ic of asbestos and a s b e s t o s i s i n th e s h o r t tim e w h ic h we m u s t, and I s h a l l only tr y , and s h a ll tr y to be very b rie f* li l a you p erh ap s know, th e d is e a s e a s b e s to s is was I f i r s t d e s c r ib e d a b o u t 1900 I n E n g la n d and s in c e t h a t t i n e , i th e r e have b e e n many, many r e p o r t s c o n c e rn in g a s b e s to s and n o tab ly those re p o rts by D octor M erewether In England, I D octor Lanza and McConnell and F ennel o f th e U nited - o f the M e tro p o lita n L if e In su ra n c e Company; by D octor Lynch nand j o th e rs , and a g a in by D octor Lanza In the Monograph, p u b lis h ed by the Oxford U n iv ersity M edical P u b lic a tio n s, e n title d ' S ilico sis and A sbestosis"* > And, fo llo w in g th e se r e p o r ts , i t was th o ught th a t ______________________________________ 81. ' i I j ve knew a l l a b o u t a s b e s t o s i s , t h a t t h e r e was n o th in g more ji th a t co u ld be known. However, I don' t b e lie v e th a t th a t view l a s u b s t a n t i a t e d and, c e r t a i n l y , a l l o f tfa re c o g n is e j i th a t th e re a re a t i l l many, many problem s co n cern in g th e j d ise a se a a b e a to a la , problem s w hich are very complex and j problem s which must s t i l l be c o n sid e re d . j T h e r e f o r e , i n a y r e m a rk s , I c e r t a i n l y do n o t j j w ish t o a p p e a r dogm atic In any w ay. I w i l l m e re ly t r y to j p o i n t o u t some o f th e th ln g e w hich a r e e s t a b l i s h e d an d seem to be e s ta b lis h e d , and o th e r th in g s which appear to be j v a lid In accordance w ith our p re s e n t knowledge. j Tou e l l know w hat a s b e s to s I s . Of c o u rs e , th e j name I s n o t r e a l l y m e t h a t r e f e r s t o a d e f i n i t e s p e o l f i c m in e ra l, b u t i t r a th e r l a a term which i s a p p lie d to a v a rie ty of sev eral d if f e r e n t substances occurring as - in the fib ro u s fo ra , end one could m ention c ry s o tile and v ar io u s o th e r ty p e s o f a s b e s to s i n acco rd an ce w ith a commer c i a l term w hioh h as b een g iv en to thorn. How, th e t o t a l number o f p e rs o n s e n g ag ed i n th e j I a s b e s to s in d u s t r y p ro b a b ly does n o t e x c e e d 1 ,5 0 0 . The j I number o f s u c h , a t l e a s t in th is c o u n try . The numbers of j l such w orkers in h a lin g asb e sto s d u s ts is not d e f in ite ly known. However, in d u s tr ia l hygiene surveys and th e frequency of j pulm onary changes in such w orkers would in d ic a te th a t only a few o f th e t o t a l number o f men e x p o se d to s u f f i c i e n t ' V .82*___ | q u a n titie s o f a sb e sto s f ib e r s develop a sb e sto sis* Thus, the c o n d itio n d if f e r s co n sid erab ly from the co n d itio n r e su ltin g from the p re se n t d ep o sitio n of fre e c ry sta l lin e j s i l i c a * C e r ta i n ly , i t may go d i f f e r e n t l y , the m agnitude j o ' the problem in one is d iff e r e n t than in the other* Vow, i t w ould a p p e a r t h a t i n d u s t r i a l e n v iro n m e n ts th a t e x is t today n e c e ssita te generally ten or acre years of exposure to a sb e sto s d u st in c o n c e n tra tio n s exceeding one m illio n f ib e r s lo n g e r than te n m icrons per oubie fo o t o f a ir * I t a p p e a rs t h a t way* T h is i s b a s i c a l l y s u b je c t to c r i t i c i s m a n d we know o f o t h e r l e v e l s o f p e r m is s ib le co n cen tratio n th a t hare been estab lish ed fo r asb esto s, b ut from our s tu d ie s and our in te rp re ta tio n , and I re p e a t, i t appears th a t in d u s tr ia l environm ents w hich e x is t today n e c e s s ita te g e n e ra lly ten o r mare years of exposure to a s b e sto s d u s t in c o n c e n tra tio n s exceeding one m illio n fib e rs lo n g er than te n m icrons p e r cubic fo o t o f a ir* Sow, o f co u rse, ex ceptions to th is occur* In i su b je c ts exposed to c o n cen tratio n s above th a t te n ta tiv e p er^ m issib le l i m i t , and I r e c a ll to your mind, the statem ent j brought o u t by D octor F le tc h e r th is m orning, namely, the j co n ce n tra tio n * A fte r a l l , i f tho c o n c e n tra tio n Is h ig h , j w e l l , th e n we f i n d w i t h i n th e pulm onary t i s s u e , many c h a n g e s J so, too, w ith asbestos* 1 How, an o c c a s io n a l c a se has corns to us f o r s+udy I i00 | w ith m a n if e s t pu lm o n ary ch an g es and p ro fo u n d sym ptom s, whos ft occupational h is to ry d isc lo se s an exposure o f le s s than ; fiv e y e a rs , b u t I a g a in h a ste n to add In th o se in sta n ce s* ! to an extrem ely high atm ospheric co n cen tratio n of long f f ib e r asbestos* In Tie* o f the experim ental s tu d ie s, the , I pulm onary d e p o sitio n o f long fib e rs o f a sb e sto s seems to | be the agent re sp o n sib le f o r changes in the lu n g which j | are id e n tifie d as asbestos is* j R ather than to c ite a ll the experim ental evidence, | j i our evidence here a t th e Saranac L aboratory, and thoee by j S m ith , Woodin and K ing in E n g lan d , have f a i l e d to show j | e v id en t pulm onary change w ith fib e rs le s s than ten m icrons j | in le n g th in our in sta n c e , and le s s than 2*5 m icrons in j ! instance of and h is w orkers, co-w orkers in England^ j and th a t, Vhereas long asbestos f ib e r s , in our experience* j caused w ell-m arked para-bronch to la r and I n te r s titia l resem -j b l a n c e , th e c o n d i t i o n , as we s e e i t in h uman s u b j e c t s e x p o s I i ed to asbestos* | l Row, as you a l l know, th e pulm onary changes due j ! to the asb esto s fib e r occur in itia lly as c o lla rs of fib ro u s j tis s u e about the re s p ira to ry b ro n c h ia ls, and the p ro g res- I sio n oi th a t fib ro s is occurs and i t is ch aracterised by ex- mr * \x j ii u B m w w a e iiMft j te n tio n in to the a d jo in in g a lv e o la r w a lls , which d is to r ts 1 those w alls and d is to r ts the formed a lv e o la r sp ace, g iv in g i: r i s e o f t e n t o w hat we i d e n t i f y as a n a to m ic a l emphysema and I _________________________ _________________________________a i ^ - L i also to c lin ic a l m an ifestatio n s o f re sp ira to ry d iffic u lty | due, perhaps, to alo n phenomena* la goInc to be a on Thursday* t h a t emphysema and perh ap s due to a d i f f u - j | I s h a ll n o t dw ell upon th a t, because th a t j I s u b je c t fo r d isc u ssio n by D octor G regoire l i ! The p o in t to be made, how ever, i s t h i s , th a t a s - j b e sto s m a n ife sts i t s e l f in an e n t i r e l y d if f e r e n t way th an j i does a sb e sto sis m anifest i t s e l f in an e n tire ly d iffe re n t j way th a n does s i l i c o s i s . A s b e sto sis i s a d iffu s e pulm onary' involvem ent, g iv in g r is e to the ground g la ss appearance in the low er lu n g , o fte n in v o lv in g th e lower lung, m anifested B o e n tg e n o g ra p h ie a ll; One c o n d itio n , in our b e l i e f , i s ac compa n l a d i n many i n s t a n c e s by r e s p i r a t o r y d i f f i c u l t y , w hereas the o th er c o n d itio n , sim ple nodular s i l l o o s l s , is often free o f re sp ira to ry d ifficu lty * The a c tio n o f In h a lin g a s b e s to s f ib e r s , 1 t h in k the concensus o f opin i or today i s , th a t i t is a m echanical l a c tio n , th a t the fib e r being fle x ib le , is inhaled In to the j re p ir a to r y bronchiaLls and because o f i t s f l e x i b i l i t y , i t can be tak en up by a c e l l and I t can be c a rrie d in to the a lv e o la r w a ll where i t i s d e p o site d and produces i t s damage* Our e x p e rim e n ta l ev id en ce seems to prove th a t s in c e f ib e r s w hich a re b r i t t l e and J u s t as lo n g , g la s s wool f i b e r s , which can be broken very re a d ily , f a l l to produce th is type o f i r e a d t i o n w hich we se e c h a r a c t e r i s e s th e pulm onary re s p o n s e : to th e a s b e s to s f i b e r * Thus we b e l i e r e t h a t th e f l e x i b i l i t y o f the fib e r is an im portant fa c to r in thecapaeity of the j a sb e sto s f i b e r to produce damage in th e lung* T here a r e some* however* who b e lie v e t h a t th e j ch em ical a c tio n s * t h a t b s b e s to s p ro d u c e s i t s e f f e c t b y t* | chem ical actio n * Supposing th a t the m laero lo g ical c o a t in g of m in e ra l su b sta n c e s i s removed* le a v in g b a re th e as bestos fib e r or spicule* allow ing a ilic a - s ilic ic acid to be lib e r a te d and th u s pro d u cin g damage* I th in k th a t th a t needs proof* I d o n 't - I do n o t b e lie v e th a t s i l i c i c acid p ro d u ces th e damage* We have b e e n u n a b le t o re p ro d u c e the experim ental effect* or reproduce i t experim entally* The k s b e s to a b o d ie s -- s o m e tin e s I l i k t t o r e f e r to i t as commonly c a lle d * b o d y - a s b e a to s is b o d ies* as th e a s b e s to s body* Why? B ecause th e s e b o d ie s a p p e a r anywhere in the lung* They o fte n l i e fre e in th e a lv e o la r apace* The body I s c o a te d w ith a la y e r o f su b sta n c e w hich g iv e s a | p o s i t i v e r e a c t i o n to iro n * w hich we an d o th e r s b e l i e v e i s j derived from tis s u e flu id s* I lik e to look upon th e a s- j b e s to s body a s a - a body w hich h a s b e e n rem oved o r i s i n - iii cap a b le o f p ro d u c in g damage* T his has been c i t e d b y o th e r workers* n o tab ly * C olus, Lynch and o th ers* and I lik e tft ; re fe r to i t as the asb esto s body ra th e r than the asbestos la body* becau se th e presence o f th is body does n o t mean th a t a sb e sto tic f ib r o s is Is p re s e n t in the lu n g . V have a e e n a s b e s t o s i s , a s b e s to s b o d ie s a p p e a r j J l in the sputum , w ith o u t e v id e n t change in th e pulmonary I tissu e * T h e re fo re , th e a sb e sto s body in the sputum i s n o t d ia g n o stic fo r th e d ise a se a s b e s to s is , I t m erely means th a t the in d iv id u al has in h aled an asb esto s fib e r and th a t th e j body has re a c te d th e re to by co atin g i t w ith iron* I have seen asbestos bodies ly in g fre e in the a l v e o la r sp ac e , w ith o u t e v id e n t pulm onary change in the a l - ! v e o lar w a lls w hich form th a t sp ace, I have seen a sb e sto s b o d ie s i n th e a l v e o l a r w a ll w ith o u t e v i d e n t f i b r o s i s , 80, th e re fo re , I lik e to look upon the asb esto s body as a body which la in cap ab le o f producing damage, th a t th e i r p r e s ence means m erely t h a t th e f ib e r has bean d e p o sited in the lu n g , and t h a t - and th a t th e ir p re sen c e in th e sputum h a s no referen ce w hatsoever to the degree o r e x te n t o f fib ro s is in the pulm onary a re a , A sbestos is is p ro d u ctiv e o f pulm onary d is fu n c tio n an d t h i s , t o o , s h a l l b e a to p ic f o r d is c u s s io n on T h u rsd a y . | S u ffice i t to say fo r the p re s e n t tim e th a t th e sym ptom atol ogy of asb e sto s la e s ta b lis h e d as b e s to s is as dom inated by i p h th lam la and I r r i t a t i n g cough. The c o m p lic a tio n s of a s - j b esto s, In h a la tio n o f the asbestos d u st, does not ap p aren tly a l t e r s ig n if ic a n tly , th e f in a l outcome of tu b e rc u lo s is , , e ith e r experim entally or c lin ic a lly . I know t h a t th e r e are th o s e o f you w ho w i l l ta k e e x cep tio n to th a t sta te m e n t. However, our c lin ic stu d y of I c lin ic a l p a tie n ts , our study of experim ental anim als, in fe c te d w ith th e tu b e rc le b a c il lu s , have f a ile d to demon s tra te th a t the asbestos fib e r dep o sited in the lung in creases the s u s c e p tib ility o f th a t tis s u e to in fe c tio n by the tu b e rc le b a c illu s , thus a sb e sto sis is q u ite d iffe re n t then or from s ilic o s is * In h a la tio n o f asb esto s d u st and carcinom a o f the lung is a ls o a su b je c t fo r d is c u ssio n on Wednesday and I s h a ll n o t dw ell upon th a t a t th is moment. There i s o fte n asso ciated w ith a sb e sto sis, v e il-e sta b lish e d a sb e sto sis, card iac enlargem ent th a t seems to r e s u l t from in c re ase d pulm onary tens io n . B ro n ch iectasis, Id e n tifie d as the dry ty p e, i s fre q u e n tly a ss o c ia te d as a c o m p lic atio n o f a s b e s to s is , and i t is lo g ic a l since the fib ro sle of asb esto sis gains about the re s p ira to ry bronchioles and about the bro n ch ial* , th a t th e re is a degree of f ib r o s is which in te r f e r e s w ith th e w all o f th e r e s p ir a to r y b ro n c h io le and whioh w i l l o fte n c a u s e a p h y s io lo g ic a l d i s f u n c t i o n , t*TM" r e t e n t i o n o f s e c r e tio n s , th u s a lso the appearance of b ro n o h lectaais* Il Experim ental evidence w ith re sp e c t to a sb e sto sis i|ii!' I n d i c a t e s , and a l s o th e r e i s some c l i n i c a l e v id e n c e , t h a t on rem oval o f th e a sb e r,to tic from th e - from th e atm osphere th a t th ere is appreciable c lea rin g o f the asb esto sis of the stu d y where C o rtiso n e has bean u sed as a p o s sib le th e ra p a u tie agent a g a in s t the pulm onary re a c tio n to a s b e a to s is . to a sb e sto tic fib e r or fo r asb ssto sis* I t leana bo a e , h o w ev er, t h a t C o rtle o n e e h o u ld ba g iv e n a t r i a l . We h av e considered th a t fo r a illc o s is , but by reason of th a fa c t th a t the individual w ith free c ry sta llin e s ilic a in h is lu n g i s more s u s c e p t i b l e t o t u b e r o u l c s i s , we have n o t fa v o r* ' ed th e use o f C o rtiso n e which a lso in c re ase s th e s u s c e p tib il ity of the lung to tu b ercu lo sis* But th a t does n o t appear to be the ease in asbestos i s , Vc, th e re fo re , consider g iv in g C ortisone a t r i a l in th e a sb e s to tic * Thank you* BY DOCTOR HATCH! I * a l i t t l e c u rio u s t o know why, i n s e t t l i n g th e ti& es f o r t h i s a fte rn o o n , D octor V orvald has a l l o t t e d more tim e fo r d iscu ssio n o f B eryllium * I thought D octor Eardy could t e l l us a ll about i t in fiv e m inutes, b u t in ste ad o f t h a t, she is a llo tte d a l i t t l e lo n g er tim e , I l l ask Doctor Hardy to ta lk on B eryllium * BY DOCTOR HARD? I P r o fe s s o r H atch and Members o f th e Symposium: There has been in th e p a st decade a tr u ly im pressive accum u la tio n of American and fo re ig n l i t e r a t u r e r e l a tin g to the e p id e m io lo g ic a l, c l i n i c a l and e x p e r im e n ta l a s p c c ta o f *>xposUre