Document nmQLnXQEQJxkprqgMeEn02aLG

FILE NAME: Sprayed Asbestos (SPRA) DATE: 1960 DOC#: SPRA013 DOCUMENT DESCRIPTION: Book Excerpt - Silicosis and Other Pneumoconioses Sweden A HL.M ARK / 2K L C C N Y ST i l Q M \S flk ' nd O llier Pueiimueojiiobcs in S w ed e n and Ollier Pneumoconioses . IN SWEDEN / i^ l Q <% Y\ Hi & & j? \ ,V $ & S V K N SK A BOKT R L \ r , E T Worsen,,St,.ckhul,,, C V I .D F .N D A I .S K i: HO O H A N D F L, N O HD S K F M Hi. AO ; K .:............ ' K A T F E M ] N r.N K! HJ A KA T I'l'A/AK ADF M J uKA O K U AN D CI . N, H r h m f / ,, n M1U. 1AM 11FI N EM AN N LTD./Lomlon /FM/. ,,urn ' / . ' CHAPTER 1. ASBESTOSIS coexistent pulmonary carcinoma. Con Since t he beginning of the present ccn- cerning tuberculosis in asbestosis, opin $ - tury it has been known t h a t inhalation ions differ. While, for instance, German of asbestos dust over a period of years sources reported t h a t among asbestos $r- gives rise to a progressive, diffuse pulmo- workers the incidence of tubercu \ f / L nary fibrosis, called asbestosis. This dis losis was not higher than in the gener case therefore occurs in nnning and mill- al population, British investigations r ing of asbestos and in manufacturing showed this complication to he not processes using the mineral. uncommon, although less frequent that, The basal parts of t he lungs are first in silicosis ( Worth A- Schhter 1957). -affected in asbestosis (Shull 19oo). The occurrence of asbestosis in There is also a reaction from the various industries has been studied in parietal and diaphragmatic pleurae and the pericardium, in which struclures many countries. The first case described secondary calcification occurs (Ahlborg in Sweden was observed in 1953 (Ahl Himsson 1956). As the fibrosis p r o borg 1959). It led to examination of 60 gresses, emphysema and right cardiac asbestos workers and thus resulted in hyp er tr oph y develop. The clinical pic ihe detection of 8 more cases ( Ahlborg Mansion 1956). The prediagnostic ture in asbestosis tallies with that in other pulmonary fibroses; dyspnoea, duration of exposure to asbestos ranged !j f t cough and weakness usually are pres from 5 to 17 years; asbestos had been cut when t he lesions arc advanced. used by 7 of the men in insulation work and by 2 in spraying operations. These H. In fatal cases the immediate cause of last 2 men had advanced asbestosis, death as a rule is given as complicating bronchiectasis, pneumoni a or cardiac 1 of t h em died soon after diagnosis. ) fE1 The insulation workers had^ milder failure. Many investigations (e. g., Gloijne lesions. 1933> i P35i i)3G, Nordmann 1938, 1939, Ethrctis 1952, and Merewcthcr t&j;* 1947) indicate t h a t asbestosis m T echnical conditions for asbestosis tySL contrast to silicosis -- not infrequently &Si$?.' ' ics c(onmmpiiliiicc.aatteedd by c:arcinoma oi tlie ?'& lune: in larre autooppssyy scries, between 'wf^-li)' and 20 per . . J' of persons with asbestosis tons w r e found to have Asbestos (Greek, =, unquenchable) is the name given to mineral substance composed of fine, usually paraded libres which may vary m .englli from 35 A lie ili u few microns to 13 c m1. In different types of asbestos the fibres differ in length, but as a rule they are pliable enough to be carded and spun into yarn which can be woven into tapes or sheeting. Asbestos belongs to the amphibole and serpentine minerals, whose best known varieties of asbestos fibre are actinolite, amosite, crocidolue (blue asbestos), tremolite and chrysotile. All are silicates b u t differ in composi tion. The most common are chrysotile. u magnesium silicate, and amosite, which is magnesium-iron-alumintum silicate. The silicic acid hound in asbestos constitutes about half of Ihe mineral's weight. Asbestos is mined mainly in Canada, Smith Africa and Siberia. Of the European deposits, the most important He in Italy, Finland and Germany. Asbestos is found in many places in Sweden, for instance in Dannemora in t he centre and Taberg in the south of the country, bu t it is not mined. Some types of asbestos, because of their great tensile strength, high re sistance to and poor conductivity of heat, are widely used in industry. To insulate pipes, radiators, exhaust ven tilators, etc., slabs, tapes or braided tubing of asbestos may be used. When mixed with a binding agent and water ' Asbestos is defined ,n th- British "As bestos I n d u s t r y Regulat ions, UiMt" us ",niy fibrous silicate material, and any admixture containing any such material, whether crude, crushed or opened." asbestos can aUo ut. spread or sprayed on surfaces. In Sweden the use of asbestos has r&y increased considerably in recent yea rs.:^^ During a 5-year period before the iate-t*^ World Wa r we imported a total .of#*? 17,000 tons, whereas after the Warpitf- once the accumulated needs arising from our isolation had been met, no less-iu t han 4B.50U tons were imported over *5^? a period of equal length (Ahlborg llanason 1956). A survey in 1058 s h o w e d ! '^ t hat about (a) Swedish tirms carried.-ir. out work with asbestos. Most of this sey work concerned insulation in the-- building and ship-building trades. Among the remaining uses of a .bestos ym was admi xt ure with various technical vii products, for instance to make rein- -f forced plastic mat er ia k. aud paste for treatment of automobile chassis. Manu- facttire and processing of slabs, blocks, etc. and sawing, grinding and polishing .<. of ashestos articles wore also rep resen te<hj The total number of workers involved ' was estimated to be between 300 and t ' Y 400. . Wrj';. Many of the above-meiuioned opera tions, particularly spraying of asbestos, -.'A. manufacture of sheeting and certain insulation jobs, are very dusty. To .-'ib eliminate or di min. jh tile dust, wet substance is used as fur as p^-sibic, and efforts are made to enclose the -A dusty operations and extract the con- /W taminated air by exhaust ventilation. When the dust concentration cannot be satisfactoriiv reduced, the workers can be protected by respirators. Not. rdf; .` 154 Tii infrequently seems to h a 1, fairly recent ie-Mis arising seriously con OWN IAVES'I Our series c cases. In 8 contracted f from variou eluding spon linings, and with csoesli was as folio case, 1955, i After the period (I9f,i ashes tosis ( cording to muniention) ti]) to 1960 The age was begun r and t ha t \vh from 33 to cases the showed mi finely -.nott with thickei pleura. In was advanc irregular li: iiilus and r wdh lungs, were bulloi basal plem emphysema abundant a ' sprayed stos has - it years. ' the late total of 'n: War, mg from no less d over - ilborg Ashowed carried of this----m the_ t radcs. I'bestON i imica! e K'ill:%le for M.niu- i -locks, 11*Iu 111* rnt ed. 'lived ' "J and "per.i- K,S| os, Tl a m . '] a . '. wrt -,Me, 111" i 011- ...ilHlI l.t rs Nut A * Aj ImmIMIK infrequently, however, prophylaxis seems to have lagged behind; it is only fairly recently that the hygienic prob lems arising from asbestos have been seriously considered. Plate XXVI I n the appendix shows a case of severe asbestosis. The duration of exposure to asbestos ranged at diagnosis from 6 to 30 years in tiie insulation workers; it was 4 and OWN INVESTIGATIONS S years, respectively, in the men who made brake linings and 17 years in Our series of asbestosis comprised 11 the asbestos sprayer. The sprayer had cases. In 8 of them t he disease was tiie most advanced lesions. He died a contracted from insulating work, in 2 few months after diagnosis, at the from various jobs with asbestos, in age of 63 years. The cause of death cluding spooling and weaving of brake was asbestosis plus pneumoni a1. Au linings, and in 1 mainly from spraying topsy showed, in addition io the ~ with asbestos. The year of diagnosis acute changes in the pulmonary par was as follows: 1950, 1 case, 1953, 1 enchyma, fibrosis increasing in inten case, 1955, 6 cases, 1950, 3 cases. sity towards the basal regions. Between After the end of our observation leticular, slate-grey strands of fibrosis .period (1955) some further c,,.scs of " e t c spherical cavities up lo the size asbestosis ha ve been dctccled. Ac of hazelnuts. The visceral pleura on cording to Aiilborg (personal com both sides w:r diffusely thickened and munication) the total of known cases up to 1960 was 15. calcified. The right side o M h e heart was hypertrophic. On microscopy the The age when work with asbestos atelectatic pulmonary par enchyma was was begun ranged from 16 to 52 years, seen to be st udded with broad strands and t h a t when asbestosis was diagnosed of connective tissue and foci of nodular from 33 to 63 years. In 10 of the 11 appearance. Within the connective i . cases the diagnostic roentgenograms tissue were abundant asbestos bodies. showed mild interstitial fibrosis or This was the only death during our 4 finely mottled infiltration, generally observation period. After 1956, how *? with thickening or calcification of the ever, 2 more deaths have occurred from pleura. In the remaining case there asbestosis. i was advanced asbestosis with diffuse, No signs of tuberculosis or pulmonary *** irregular linear densities around the carcinoma were observed in the 11 hiius and down towards the base in m m during the observation period*. both lungs. Between these densities were bullous rarefactions. There was r basal pleural thickening and apical 1 This case wav described in detail by A h l - emphysema and the sput um contained burq II(mason (l'.)j(h. abundant asbestos bodies. ' After the observai inn period piilmnimiv a i *'iu r r \\;ib ItMiiwi in 1 c.tsf* A i'a 'x a s - i M m .Hft' Roentgenographic progression occurred in 1 case only. This was u 5t}-\ ear-old insulation worker wi th "at least 20 years of exposure" , whose roentgeno gram 6 years after diagnosis showed increase of pleurai calcification ami of generalized emphysema. He had con tinued work with asbestos after diag n o s i s 1. Two of the men received disablement benefit. One of them, the man who died, was compensated at full rate. In the man with roentgenographic pro gression, disablement was first assessed ns 15 per cent ami later as tin per cent. DISCUSSION Although asbestos has been used in dustrially in Sweden for several decades, no cases of asbestosis were diagnosed before 19,10. Tin- reasons seem to have been manifold: a relatively long period of exposure to asbestos dusl is neces sary to produce the disease, and ex posed persons were not systematically examined before the first case was diagnosed; further, the n u m be r of persons at risk, particularly in the building industry, probably lias greatly increased in very recent years. Periodic medical examination or asbestos workers thus was instituted only towards the end of the period covered by our investigation (1931 to 1 In 3 other cases the (sense progressed after the observation period. 19.>it, ami not all the cases of ashestosis.^ hitherto demonstrated had then been notified to the insurance authorities. v-? The cases we have presented therefore comprise nnlv a proportion of those atw ** present known. They nevertheless show's if, that also in Sweden asbeslosis may constitute a grave health hazard -V'*Among our 11 cases there were 3 deaths .;/$ from occupational pulmonary disease. The time required to produce asbestosis was no mure than about 9 sears in 2 cases. A survey of ail asbestos workers m ... Sweden has i;r u planned and should -iprovide further kuowbdge of the ri-k -jp of nsbesloM- The problem of nst,(siosi>. is now bcir." '-'/orousiy utfucV'd bv the factory inspection authorities, ami -.h we may anticipate that the risk wdl ' soon be reduced by technical pro pi n taxis. I'o pi event asbestosis it is essential that technical and medical measures should rapidly be enforced. .<*i W SUMMARY - . - ` *:$ Industrial use of asbestos has a fairly "4V'.' long history in Sweden, b u t asbestosis C^l" was not demonstrated in this country /vV I until 1990. After Ahlbnrg ( 1956) directed' aw j attention to the occurrence of this disease, further investigations showed t h a t it was not rare. :,U -<it*- At the end of our observation period & (1956), 11 cases of asbestosis were known; the first was diagnosed in 1950. The work with asbestos hurl been m- suiatim. of Jiralv in 1 c: mortars and v>l` or cah.i rocnlg' la no mmiar ago at \ ears e\posu One i rrlmi arliiT magne ill.' p 1 dustrn and p talc, s I he w< or le'" as sir.] soapsi Comm small 1 IH.'Und etc. O quart i t oce is too :iR|jfS(Osis JlCll been tli r>ri\(.'s. therefore f those at less show osis may hazard. 3 deaths disease*, isbeslosis 'ars in 2 orders m d should tli**. risk she stosis irkoiT bv lies, ami risk will <nl prosis it is medical iiforced. a (airly bestosis country directed o! this S.1U". oil i period is were in O '* II 111- sulating operations in S cases, making the obsorvulioTf period' and in another of brake linings in 2 cases, and spra\ ing case there was rocntgenographic pro in 1 case. In l o of the men the pul gression. Disablement benefit was & monary fibrosis was mild at diagnosis and with or without pleural thickening awarded m 2 cases. This investigation, despite its limited or calciiication. The remaining man had scope, indicates t h a t in Sweden asbe.s- roentgenographically advanced disease. tosis is an important occupational In no case was there coexistent pul health risk. Strictly enforced technical monary tuberculosis or cancer. The protection and medical supervision of age at diagnosis ranged from 33 to 03 exposed persons are therefore necessary, years and the preceding duration of especially as the use of asnestos has r - exposure rront -1 to 30 years. considerably increased in the past :vr*. One m a n died of asbestosis during decade. t'- CHAPTER 2. TALCOSIS I. -- - Trchnical conditions or talcosis and earlier observations. Talc, which is a magnesium silicate, is widely used in the pharmaceutical and chemical in dustries and in rubber, cleaning mat crial and puper works. In the deposits of talc, which are lound over much of i he world, the mineral occurs in more y or less compact form, ami sometimes as stone, as shown by the designations soapstone, Speckstein and potstoue. i& Commercial talc trequently contains small quantities of closely related compouncs such as tremolite, anUgonte, etc On the. other hand, admixture oi ft quartz is relatiwlv rare, and when il occurs the coni cal of free sdica f is too low tii be of pathogenic sigmii- cance. In analyses by Sdiultz A Wil liams f l `j-12) 25 specimens of talc were found lo be free from quartz, 25 con tained traces of tins substance, and m I there was 3 per cerd of quartz. In specimens of Swedish soapstone w e failed to demonstrate quartz with a method that gives reactions down to 1 per cent of the mineral. Almost wi t h out exception, industrially used talc is in powder form and frequently it is milled near the. mine. The dry, light talc dust everywhere present m the^c mills is a troublesome h y g ie n ic p r o bl em , 1 After Ih.'ni ttiore wort. J rrn^e tenths. ! f r n m n v i * M r K i s n ' o n e r-D>! ) f ; i ' M d*>h<*v'uvs with pulmon.iry caticir. fjp'rd *