Document peZ3jOm8D6aDQNDxjbyRzLvZj

FILE NAME: Talc (TALC) DATE: 1959 Nov 19 DOC#: TALC125 DOCUMENT DESCRIPTION: Medical Journal Article - Toxic HazardsTalc Pneumoconiosis 1084 THE NEW ENGLAND JOURNAL OF MEDICINE Nov. 19, 1959 admirers, and should not be difficult of attainment. The Herrm an L. Blumgart Chair in Medicine will raise to the endowed list and still further dignify a program of medical teaching that has become at the Beth Israel Hospital under Dr. Blumgart an area of learning and research of the highest quality. It will be the first endowed chair to become perma nently a part of this important hospital. Fortunately, the inauguration of the Herrman L. Blumgart Professorship fund does not coincide with any early retirement plan with respect to Dr. Blum gart himself. His academic retirement is still two and a half years distant, and long before that time his chair will have become an established fact. Dr. Blumgart, who became director of medical research at the Hospital in 1928, has been its physi ceidainto-irn-i-nc-hciheifefsinocfe C1i9r4c6u.latHioenisanaldsoathme edmisbtienrguoifshthede editorial board of the New England Journal of Medicine. forSmu.cceTshsfeuldTisereaasetmseunpterovfenTeedtafnourtsy,-ebiyghCt hhloourors after a wound from a pistol-shot. The remedy sweavseraadlmdianyiss,tewrietdh, rbeylieifnhtoaltahteiosny,mapttoinmtesr,vaanlsd, tfhoer patient recoBveorsetdo.n M. & S. J. November 24,1859 MASSACHUSETTS MEDICAL SOCIETY TOXIC HAZARDS* T alc P neumoconiosis! duTstainlcg iasgeunste.d Mexotsetnsoivf eltyheinyeainrldyusdtroymeasstica pfriolldeurctainodn of approximately 500,000 tons is consumed by the follow ing industries: ceramics; rubber; paint; paper; roofing; ianssepceticciifdice; mainndercaol,smheytdicrso.usAlmthaogungehsiutamlc siislicthatee na(Hm=eMfgoar[mSiiOxtsu]re)s, oinf aingdruosutrpyotfhme itneerrmalstainlccluisdinapgptlailecd, steorpveanrtiionues, dtioeslomthioteugahndthteryemdoiflfiteer tihnatchheamveicsailmciloamr ppohsyitsiiocna.l pUronpfoerr ttuitnieasteloyf, sformeee csoilmicamer(SciiaOl*t)alcasncdonmtaainy acpapurseeciasbilliecoqsiusanif they are not used cautiously. ComTmhiistteue oonnInodfusatrisaelrieHseaolftharatnicdlesthepuPbalnisehledoncoC-hoiplderaHtiveeallyth boyf tthhee Cpaonmelmpitrtoeveidoens Pliuabisloicn Hweiathlththoef tMheasMsacahssuascehttusseCtthsaMpteedricoafl tShoeciAetmy.eriTchane ACceandteermsyaroefaPcetidviiatiteriscso,f wthheosCeomBomstiottneeaonnd AWcocirdceenstterPrPeoviesnotnionIn. formation chairFmroamn;thKeaCrloTm.mBiteteneedoicnt,InMdu.Dst.r;iaHl aHrreiaeltthL,.GHeoarrdgey,FM. .WDi.l;kiGnse,orMge.DE.. ManodrrHise,nMry.DF..;HRoowbee,rMt C.D. .Thompson, M.D.; Robert L. Quimby, M.D., pnAeulmthoocuognhiosTishoinrelG' eprmreasennyteidn s1t8u9d6i,esthoerfeaseceamsse toof htaavlce b1e9e3n3,liwttlheenintDerreesetseinn'threepdoirsteeadsehiins thsteudUiensiteodf Swtaotrekserusntiinl twhoerktmreemnolhitaed taablcnoirnmduasltrcyh.esHt ex-rfaoyunfdilmthsatthamtawnyereofctohne sfiasctet ntthwatitha anupmnebuemr oocfonaiodsdisit.ioHnaolwerevpeor,rtsin osfpitaebnoofrmthael ftiilomnsalindistaealcsewwoerkreersrealupcpteaanrtedto, macacneyptsttuadlcenatss oaf coacucsuepaof ptonepurmovoecotnhioastisthseinpcuelmsoonfaewry afuibtroopssiys wdaastaacwteuraellyavdaiuleabtloe taaslca rcaothntearmtihnaannttoofstihliecat,alwchoicrhinmsaoymehapvreevbioeeuns oinchcaulpead ttioone.stNabolwish, htohweevfaerc,t suthffaitciethntedpautalmhoanvaerbyeefinbraocscisumseuelnateidn talc workers* is quite distinct from that seen in silicosis. conEixoasims inshaotiwosn tohfatthmeucluhngosf itnhe andovramncaeldlutnaglc tipssnueeumhaos buleeesn. rAeprelaacsedofbnyecfirborsoisuswtiitshsuecacvoitnattaioinninmg amyaoncycutarlcinsptihce mreassesmesblionfgfaibsrboeusstostisbsoude.iesInhavsoembeeecnasfeosunfadirtloy blaergeembroedds ded in the scar tissue. These have been called talc bodies athnadt sceoenmtaintos abelaargsseocaimateodunwt iothf ttrheemoinlihtea.latTiohne offibrtoaslics does not have the whorled pattern that is characteristic opfressiulimcoasbisl.y Tishediaremctoluynrteolaftefidbrotosisthine taamlcopunnetumofoctaolnciosinis hparolelidf.eraAtivltehoruegahctiotanl,c,thuenlriekteentsiiolinca,ofdolaersgenoatmocuanutsse oaf talc by the lung results in sufficient fibrosis to impair pulmonary function seriously. The x-ray findings in talc pneumoconiosis are not shpileacrifiecnallalyrgdeimagennot,stitco.geTthheer ewaritlhy cahnanagcecsenctounastiisotnofofsotmhee brarothnecrhopvoaosrcluyladrefimneadr,kifnlgaks.elikAe saretahse ofdiisnecarseeasepdrodgerensssietys acpoapleeasrceinintbooltahrgleundgensfieelmdsa,ssaens.d, Infinsaolmlye, cthaesesse thseeemx-ratoy fthilemporefsetnhcee cohfesmt ahnays sma adllapbplelbesd. aCpapveiatireasncme,aysuogcgceusrtining atidovnanhcaesdbedeisneafsoeu. ndA ihnigthreminocliidteentcaelcofwoprlkeeurrsa.*l cIanltceirfiecsat ingly enough, there does not seem to be a direct correla tion between the presence of pleural plaques and pulmo nary fibrosis. thaTtheofcloitnhicearl cphircotnuirce pouflmtaolcnarpyneduimseoacsoen.ioTsihsereosnemsebtleiss imnsaiydiobues,,pwreistehntgriandituiaallllyy, ibncurteaussiunagllydyaspnceharo. nAic dbrryonccohuigtihs dmeavyeloopcscuar.ndAsthwe icthouogthhebrecpoumlmesonparroydudcisteivaes.e, Hcoermpoupltmysois ntrailcele.maIyt aisppneoatr,knwoiwthn ewvehnettuhaelr fpaaitliuernetsofwtihthe trailgchtpvneenu masopcoatniieonstiss whaitvhe sailnicoinsicsredaos.edThsuesrceeipstinboilistypectoifictubtreeractumloesnist for talc pneumoconiosis. Control of the frequently super tihmepomseadjoracpurtoeblaenmd cinhrtohneicmpeudlimcaolnacrayreinoffectthieosnes pparteiseenntsts. theProplorondguecdtiaonnd ionftenase penxepuomsuorceontoiostaisl.c isUnnefcoerstusanraytefloyr, until recently, talc has been widely regarded as innocuous The New England Journal of Medicine Downloaded from nejm org by J C METCALF on Apnl 8, 2011 For personal use only. No other uses without permission From the NEJM Archive Copyright 2010 Massachusetts Medical Society All rights reserved Vol. 261 No. 21 CORRESPONDENCE 1085 so that suitable precautions to prevent talc pneumoconi opsriessehnatveknonwotledbgeeencotankceernnining mtaalcnypnceausems.ocoInniosviisewit oifs oshbovuioldusbtehaptrwotoerckteerds ebxypoasdeedqutoatetheexrhisakusotf vtaelnctilianthioalna,tioorn, if this is not possible, they should wear proper dust respi rators. A lbert O. Seeler, M.D. Medical Department Massachusetts Institute of Technology R eferences 1. TAhnoarteoim, ieC.derDSiteauSblpuencgkesnte.inBluentgtre.: f.epinathB, eAitnraagt. ^pathologischen 20:85-101, 1896. 2. Dreesen, W. C. Effects o certain silicate dusts on lungs. /. indust. 3. Mminoipngi nd'u, ^st?oVn .h9uHm.a,nalnudngD. uAriracnh,. ITn.duMst.. HMeaeltchu of inhalwi 12.182*197, tele 1955. 4. Sdumsittsh. .AAm..R/.. RPoleeunrt gale ncoall.ci$fi7ca:3ti7o5n-38re2,su lting 1952. fr om exposure to certain Geographic D istribution of C ertain D iseases muTnhiteiesfonlalomweidn:g diseases were reported from the com DDyysseenntteerryy,, abmaceiblliacr:yW: oArrcleinstgetro,n1,. 3; Boston, 42; Brockton, H1:avCearhmilblr,id6g;e,Ly6n;nC, h3e;lsMeaa, ld1e;n,Fr2a;mMingarhbalmeh,ea1d;, G2r;otNoant,ick1;, S1o; mPeeravbiolldey,, 11;; QWuaintecryt,ow3;n,Re1a:dinWge, ll1e;slReye,ver1e;, 1W; oSbaulernm,, 11;, totEaln,c8e0p.halitis, infectious: Charlton, 1; Danvers, 1; Lunen buHrge,pa1t;itiNs,ewinfBecetdiofoursd:, A1b; intogttaoln,, 41. ; Athol, 1; Bernardston, E1;asBt roLcokntognm, e1a;doCwa,mb2r;idgFei,tc5h;buCrhge, lse1a; NFaovratl HDoesvpeintas,l, 13;, MHaevdefrohridl,l, 11;; NHoalhyaonkte,, 81;; LPoewabeolld,y2, ; 1L; ynSna,ug1u0s;, M1;aldSepnr,in1g; fWieelds,tp2o;rt,S.t1o;wW, o1r;cTesatuern,to1n; ,to1ta;l,W4e9s.tover Air Force Base, 1; Lymphocytic choriomeningitis: Cheshire, 1; Everett, 1, totMMal,eanl2ain.rigai:tisB, osmtoenn, in1.gococcal: Agawam, ,1; 0 Bourne, 1l; Lowell, 1; Lynn, 1; Medford, 1; Somerville, 1; Spencer, 1. MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH COMMUNICABLFOE RDIOSCEATOSEBSERIN, 1M95A9SSACHUSETTS R sum D isease BCrhuacnecllroosiids ............................................................................ CDhipichktehneripao x........................................................................ DDEnoycsgeenpbthietarelyi,t.i#.s.b,..a..ci.ni..lf.le.a.c.r.ty.i.o...u....s........................................................ GGGeorarnmnouarlrnohmemaaeaisn.l.eg..su.4i.n....a....l..e.............................................................. HLyempaptihtoisg,rainnufelocmtioausven...e.r..e..u..m................ MMMeaeanlasirnleigasiti..s...,.......m.......e...n...;i...n....g....o....c....o....c..c....a...l.................................. MMMeeennniiinnngggiiitttiiisss,,, sPptnfaeepiuhfmfyeloroccbooaccccciaallllus........................... MMeenniinnggiittiiss,, sutnredpettoecrmocicnaeld ...................... MPoulimompsy.e..l.i..t.i.s...................................................................... SSaclamrloentelfleovsiesr ................................................................ STTyuripbchehirilcnisuolsoi..ss.i.s..,......p....u....l....m......o....n......a....r..y.............................................. TTWuyhbpoehorocpiudinlogfseicsvo,eurogth.h...e...r.......f....o...r...m......s................................... O ctober 1959 0 0 170 0 1271 80 4 34 167 0 49 0 t 151 7 3 2 1 0 16 226 29 34 76 236 0 118 3 0 44 O ctober 1958 1 1 251 1 1210 14 2 96 212 0 25 0 0 109 6 4 1 0 0 42 183 5 45 102 210 1 117 6 1 121 Sev en-Year M edian 1 1 264 2 1107 14 2 59 212 0 34 0 50 76 S 1 0 0 10 404 109 23 110 191 1 145 9 2 121 Comment GeDrmiseaansesmebaeslloews, tmheumsepvse,n-pyoelaiormmyeedliitaisn, wscearerlecthifcekveenr paonxd, whDooupriinngg cOocutgohb.er the incidence of scarlet fever was at _its lowWesitthlevbeultinotnhee Sextacteep'stihoinsto(ry1.957) whooping cough was ahtistiotsryl.owest level for the month of October in the States at Dthueriinr gloOwcetsot bleerveclshifcokrenthipsoxmoanndth Gsienrcmean191m8eaasnleds w19e4r0e resDpeiscetiavseelsy.above the seven-year median were bacillary dys entery, infectious hepatitis, measles and salmonellosis. deDncuerifnogr Othcistombeornbthacsiilnlacrey 1d9y4s2e.ntery was at its highest inci ^Meningitis, Pfeiffer bacillus: Arlington, 1; Chelmsford, 1; SaMlemen,in1g;ittiost,alp, n3e.umococcal: Brockton, ,1; ,,Souutuhb-nj dge, 11, totMal,en2i.ngitis, staphylococcal: Worcester, 1. DiMghetnoinn,gi1ti;s,Fruanmdientgehrmamin,ed1;: HBaovsetrohni,ll, 31;; LCyanmnb,ri2d,geM, ed1; ford, 1; Somerville, 2; Swampscott, 1; Wakefield, 1, WoProcleiostmery,e2li;tisto: taAlm, e1s6b.ury, 1; Attleboro, 2; Boston, 2; C_ am b1r;idHgoe,ly1o;keC,on1;coMrde,d1fo; rDde, e1rf;ieNlde,w1;BFeadifroh^av,enl,; 1P;itFtsaflimelod,uth1,, WQuailnthcyam, 1, ; 2S;aleWma, te1r;toSwomn,ers1e;t, W1;elSlepsrlienyg,fie1ld;, W1,eSnuhtatmon,, 11,, WeSsatlbmoroon,el1lo; sWis:orcBeosstetor,n,4;1t2o;talB,r2o9o.kline, 2; Fall River 3, QLeuiicnecsyte,r 21;; SLhyrnenw,s4b;urMy,ar1b;lehSepardin,g1fi;eNlda,tic1k,, W1,oNrceewstteorn,, 51,, CORRESPONDENCE OBSERVING THE PATIENT ingToin tPherosEpdeictotirv:e aDnrd. DReotrrno'sspeacrttiicvlee,S"tuSdoimese oPfrothbelemEstioAlorgisy othfeDJioseuarsnea,l", mwhaidceh inaptepreeastriendg irneatdhiengS--eptpelmeabsearnt,17prwofiuteabolef and easily accessible even to one not properly schooled in theTsehemantatetursr.e of his paper, d,elivered as a lec,ture .m _p_re_ vofenitlilvneessm, emdiacyinneoot nhawvaeyspeorfmliettaerdninDgr.aDboournt tthoe dowceclulrruepnocne onnaeturdailsthiniscttoioryn ooff diimsepasoer.tanTcheisinis ctlhineicdailffesrteundciees beotlwethene opbastieernvtins goonne e'hsasownnotpasteieenn;tsthaendtesrtmudy"irnegtrohsopsepcittiavle chstaurdtsiesol appTehaerssttuodyapopflyditsoeabseotihs tthheesestumdeythoofdssi.ck people; the more omfatihneinmg htehehassamseee.n, Cthoenbtientutearl acrditoiccatolr aist,teontthioenr mtoattaelrls rheis ccaosrerse,cttsheorccoomrrmoobnopralatecse haiss wcleinllicaasl tkhneowunleudsgueal;,itcosntrteinnugothuesnlys bMeleidefiscaclonbfoiormksedabrey eaxpseurbiesntictue,teanfdorshoabkseesrsvoinmge tphaattieanrtes,noats. t"rtahCveehlmanbaconeo,kwschoaomrehbaifsnoirsnegternaovpfeoplrionrhgtium;nasietuyltfh."aonridtyvipsrioonpetrolysbeeelo.itn,gms atoy hpealtpteran bdouct tothremfinsedlveas;feawnecwaseesnttihtyatisrerseecmogbnleizendo aknndowren- The New England Journal of Medicine Downloaded from neim org by J C METCALF on April 8, 2011 For personal use only No other uses without permission From the NEJM Archive Copyright 2010 Massachusetts Medical Society All rights reserved