Document pkbzvj0NBn3ev7ZBXpM479mj

FILE NAME: Sprayed Asbestos (SPRA) DATE: 1961 Aug DOC#: SPRA015 DOCUMENT DESCRIPTION: Medical Journal Article - Asbestosis in a Worker Engaged in Automobile Undercoating MEDICAL INTELLIGENCE -- BRl'GSCH AND BAYLEY 379 2fu Ne 8 medical intelligence #1? . '?uv*. 35--<. L*.*d'-' *". ' : '>.A monarv fibrosis. Two wedge biopsies from the lingula and the lower lobe showed, microscopically, many areas of foreign-body reaction as well as a few typical asbestos fibers. The foreign-body reaction appeared most marked ^rou areas that stained blue and contained unidentifiable ho mogenous material. Marked connective-tissue reaction was present. There was no evidence of cancer, tuberculosis or SBESTOSIS IN A WORKER ENGAGED IN AUTOMOBILE UNDERCOATING H e i n r i c h G. B r u o s c h . M .D .,* a n d H a r o l d B a v i .e y , B.S., C h . E . | BT h eV alien t made an uneventful recovery, his fever sub sided and he was discharged on January 9 greatly improved. He continued to have some greenish tenacious ,an slight shortness of breath, with wheezing. He r^ urne^ work to the same company and was assigned as a par s distributor in the Service Department On re-examination he still had a moderate cough, with slight dyspnea on exertion, 12 months Inter. T he occupational history revealed that this man boston was engaged in his present occupation at the same company as an automobile mechanic for ten years. 'HE term pneumoconiosis applies to diseases of Previously, he had worked for two years at a saw ;the lungs caused by inhalation of foreign m a manufacturing company, where he operated a cold ul. A more specific diagnosis will depend upon press, and before this he had worked at a gasoline sta hect identification of noxious substances in air tio n .'H e had a complete physical examination, in nples, SDutum and, whenever possible, lung tissues, cluding a chest film, which was interpreted as nor cons 'the occupational hazards causing penumoco- mal, when he was first hired ten years before ad osis.Vsbestos has been identified in exposed mine irkers. v.oikers handling insulating materials cornsect lamely of asbestos, workers in the brake-lining Sustrv and workers engaged in asbestos spinning, 'ding and weaving.1 Although asbestos bodies ha\ e mission to the hospital. His work consisted of the servicing of new automo biles, essentially from one American car manufac turer. . . With the exception of fiberglass in small quantities, !n found in the lungs or sputum of patients with no material of significance in occupational diseases evidence of pulmonary disease or heavy exposure, ie presence of asbestos bodies in the lungs of^ a tier :r. an occupation hitherto not connected with testcv makes the following case worth reporting. was used by this worker in his job. In addition to his routine duties for the last six years he had been engaged on a contract basis in applying an asbestos-base undercoating on new cais. Case R eport This operation was performed in a wing of the garage measuring 15 by 26 feet and closed at both F.T.. ; 41-year-old automobile mechanic, was admitted to [ho'pitV- in the vicinity of Boston on December 15, 19o8, nh a:. t:ite febrile disease. He complained of cough shortss of o eath and yellowish expectoration. H e had been urm: several weeks previously, when he had noted the radual -.set of productive cough, weight loss and excessive iline rOn acrr.ission he was febrile and coughing. The temperbare \s a ; moderateiy elevated. On physical examination iere wa: a congenital anomaly of the right arm and cyano.' of the ears." Rales and rhonchi were present over dth h im = There was no clubbing of the fingers. Laboratory jud'es 5. .wed "yeastlike bodies" in the sputum. Gastric psliir.e:- ...ere negative for acid-fast bacilli, and a Papanico- FJU ,7 was negative for malignant cells. Blood studies M>`.sed a hematocrit of 47 per cent, a white-cell count of D.800. .:h 72 per cent neutrophils, and a sedimentation kte of . ' ~.m. per hour. A tentative admission diagnosis of hetm-v fX-ra. arcral nsitlr feruas; prdia' -:s was made. ., , , ,, -'-as taken on the following day showed diriuse - Vifation of the lungs by minute, discrete nodular ard considerable accentuation of the peribronchial is markings, particularly of the lower lobes. The - ' lours wore not clearly defined, being partially wscun a the infiltration. There was considerable bi ^'trai - ' *opathy. , , . r. A fc:, - j>COp> and broncho-jrapny pf-xtoimed on lJc 'nIotHwVel.dLj " tUr aUcVhielWo bVr oivnxcvh..i-t-i-s--." T h o ra c o to m y m tb.e ; left lingula on January 5, 1959, revealed that >.ad a fine, granular appearance, suggesting pul- roirwii of medicine, lefts University School of Medicine phvsician, Masqat husc os Department ot Labor ami -..eei, M avachusetU D epnrtm uit of l-ahor and In d m liu - ends by wide sliding doors, which permitted the en trance and exit of automobiles. There were large windows at one side of this wing. I he undercoating operation was carried out by means of a hand-type spray <mn operated at a pressure of 110 pounds per square" inch and directed against the underside of the raised car. N o mechanical ventilation and no respiratory protective devices were in use during this operation. A considerable amount of the tarry asbes tos-base material was dispersed through the work area and onto the worker's clothes and face. T he un dercoating material was pumped from a 55-gallon drum. Each car required approximately 4 gallons^ of the material and thirty to sixty minutes of spraying time. About 1 to 3 cars were sprayed daily by the patient daring the first five years, and less during the last year. Since the illness suggested the possibility that the undercoating of automobiles was responsible for or contributory to the acute pulmonatv disease, it was deemed advisable to investigate the undercoating operation presently performed by many automobile sales and service agencies in Massachusetts. T o obtain background information, contact was made with the industrial-hygiene units of the large automobile as- th v.Vi 265 No. 8 MEDI CAL IX'I EEI. IGEXGE 1 ERRIS ET AI. 'Si! 1 wuomic findings, Tim material that the patient contained asbestos of various filler sizes in an imhalt base and was held in a mastic form by a sol vent of the petroleum-distillate t\pe. Lung biopsy revealed the presence of asbestos bodies of chaiacternnc appearance. I he unusual finding in this case woikeis w ith )i olonged an d continuous r\;)o<uie to dlls opemlion are made ' \ c arc indebted to R E I 'a n a n d . M D . oi 1 urh.buig ioi permission to repoit this c u e am! io II J Sparling'. M D . pathologist, Burbank Hospital. F i t th h u r a fur* it view I tkc pathological specimens ", a the presence of numerous amoiphous bluish- staining deposits fairly widely dispensed throughout R eferences ire specimen and surrounded by mflammaton and ..o:mcctn olissuo lcaclion. 1ho x-inv appcnrmicc v finely granular infiltration throughout both lower eves and the possibility that the sputum abo con.^ined asbestos bodies ('Voastlike bodies' ) indicate rhac the lung process in this man was of a chronic 'Mitre consistent with pneumoconiosis and the di rect local action of foreign materia! such as asphalt ar.d asbestos. This is also suggested by some of the M tests obtained in the survey. ' p ^ M `SCaUS c c ut , a, wns m q !'l' W o o c l..|i!< Brown, 1 Huh P r Pmumocnmosis: Industnal diuases . / it.e Urn* cau'ed m f i n ! 2b8 p p Lo n d o n -\it,o!d 1937 P. ] i 3 * " NEPHROTIC SYNDROME CAUSED BY PROBENECID" T homas F F erris, M .D ..t W vlter S. M o r g a n . M .D..t and Erom the point of view of occupational health it H oward L evitin. M.D. -- significant that the patient, in contrast to the . meets ooseivcd in the smvey, had been daily and N E W H A V E N . C O N N Fa '.T TC U [' continuously engaged in the underroating operation mote than five soars, that no history of previous .eng disease or exposures to noxious material could hr demonstrated and that the survey had shown mat the spraying proceduie was accompanied bv .om-idei able back splash into the breathing zone of the worker. ' HE nephrotic syndrome lias been reported to oc ' ' cur in the course of therapy with a number of drugs including trimethadioneT; paramethadionek meicmal oiuieticsk tolbutamide0 and pcrclkoratek as well as in association with semitivitv to poison oak; and bee sting.8 ! he cross-sectional sutvey here tcpoited indicates mat under prevailing methods of operation, the use asbestos-base undcrcoating, when limited to wort exposures, lias not resulted in an occupational i.azatd. However, if this operation is performed conhnrously without adequate ventilation and protecu'-e respiratory equipment it may expose the worker ' trie potential danger of pneumoconiosis. As a protective measure, it is therefore recommend In the case repoitcd below, the nephrotic syn drome appeared to be the result of a reaction to probenecid/ Although proteinuria and renal failure are known to occur in the course of chronic gout, the neplnouc syndrome has not heretofore been reported as a result of gouty nephritis or in association with piobenecid therapy. C ase R eport ed that workers using asbestos-base undercoating material over a period of ten hours weekly or more .or periods longer than one year should observe the <o.owing rules: Pi e-ernp!o\merit and pci iodic x-i tv studies of the oaesr, with the use of Jarge-si/ed films fl4 bv 17 inches) should be made. iVhen possible the workers should be rotated. Approved respiratory devices, with additional piotection for the eyes, should be worn. _ Mechanical ventilation should be provided in the immediate vicinity of the work area. S ummary A 52-> car-old man was first seen at the Grace -N ew Haven Hospital in January, 1954, because of acute arthritis of the right knee. Physical examination was negative except for the painful swelling of the knee. The blood pressure was 118/85. Hrinalysis was negative. The nonprotcin nitrogen was 38 mg,, the fasting blood sugar 100 mg., and the serum uric acid on 2 occasions 9 0 mg. and 9.9 tee. per 100 ,] The acute attcu k of gout responded m 21- bouts without -pt.cifi< the rape and he was discharged on probenecid, 1 gin. twice a day, and a low-purine diet. Eighteen days later he ex perienced urticaria, which subsided w-hen probenec d was discontinued. He was then advised to stop probenecid and to take colchicine, 1.2 mg. daily-, as prophylaxis against tutther acute attacks of gout. ' ' In March. 1954, probenecid, 1 gni. daily, was restarted When next seen in May, 1954. the patient had gained 10 kg. (22 pounds), but no evidence of edema was present. 4 w-o weeks later the weight had increased further, and gross p i t t l n r c e d e m a w a s n o t e d . N o u r i n a l y s i s w a s done at that On the basis of a clinical and pathological study a case of pneumoconiosis in a worker engaged |n tne undercoating of automobiles with an asbestosjave compound, a cross-sectional survev of this operai!on m the Commonwealth of Massachusetts was unoertaken. Appropriate recommendations to protect IV". the D e p a r tm e n t o{ In te rn a l M ed ic ine, Yale U n it emits School of Mfcijcnc. Aided bv grants fiom the United States Public Health Service , H-834 l .nd the L a w ren c e Gelb F o undat io n t Vssistant resident in medicine, Y ale -N ew Haven M tdica! Center Medicine "* C,'mC:,i P'ofcssor of medicine, Yale University School of SVs.staiH piohssor of medicine Yale University School of Medicine established linpuiiiator, American H eart Association. ' r In the form of Bencmid. Merck Sharp and D nhmc. West Point lYmnvKamn 380 THE NEW ENGLAND JOURNAL OF MEDICINE Aug. 24, 196! semblers and other state organizations responsible for the investigation of occupational health hazards. The case history was summarized and forwarded to these organizations with a request for information regarding whether similar cases had been observed in the past. None of these agencies had knowledge of any similar experiences. The information revealed that in plants outside of Massachusetts, an undercoating compound that contained a rubber or cork base was in use. In Massachusetts most of the automobile agencies are using an undercoating material that contains asbestos in an asphalt medium. _ T he undercoating compounds used by the dealers included in this survey were manufactured by 5 dif ferent companies. T he material consisted of an as phalt base containing approximately 50 per cent of asbestos by weight. About 10 per cent of the constit uents were fillers such as clay. The material was of a mastic consistence, with a petroleum distillate such as a high-flash naphtha or kerosene as the solvent. Fifteen different types of American automobiles sold and serviced in Metropolitan Boston were se lected for a cross-sectional survey to study the under coating operation and its potential hazards. Fiftyfive automobile sales and service agencies were visited to obtain information on the number of cars under coated annually, the number of employees engaged in this operation, the methods of operation, the protec tive equipment worn by the operators and the com position of the undercoating compound being utilized. bile raised by means of hydraulic lift. The operator sprayed the underside of the automobile. The actual spraying operation required approximately fifteen to thirty minutes. There was considerable back splash of the material, striking all parts of the operator, including the face. This contamination resulted in a reluctance of workers to undertake this work as a full-time occupation and led to frequent rotation of workers in this particular job. General means of ventilation such as a wall fan were provided at a few locations. It was noted that no special precaution"ere taken to prevent the inhalation of the disperser undercoating compound. Some of the operators wercprovided with plastic face shields or coated the!) faces with petroleum jelly. Industrial-hygiene units that had surveyed the ur dercoating operations in the past were interested pri marily in the solvents used in the undercoating ma terial. Their analysis did not reveal any substanliai hazard attributable to these solvents. Our survey uaditected at determining whether asbestos constituted a hazard after the prolonged use of certain unrlejcoating compounds. Atmospheric samples were ob tained during the actual spraying of the undei- ` coating material. The average concentrations varied from 500,000 to 1,500,000 particles of asbestos pc cubic foot of air. Microscopical analysis showed tha j the asbestos was present in the form of dint pai f tides, less than 10 microns in length. The presen ! maximum allowable concentration for asbestos dust j T he survey revealed that the number of cais un particles less than 10 microns long dispersed in ht dercoated by these establishments ranged from as working atmosphere, as set by the American Con low as 2 to as high as 600 per year. There was a re ference of Governmental Industrial Hygienists, h cent tendency to reduction in the amount of under 5,000,000 particles of asbestos per cubic foot of aii. coating as compared with previous years, since most The maximum allowable concentration for lonw fiber- of the new cars are delivered undercoated by the g i eater than 10 microns in length has been tentaiiic- f assemblers. ly set in Massachusetts as 1,000,000 fibers per cubri 1 T he undercoating operation was carried on as a foot of air. T he atmospheric contamination due to f rule by 1 or 2 employees at the close of the workday, asbestos in the operations surveyed, based on avail- I when the operator performed the undercoating opei- able standards, was not excessive. It was noted tha' j ation on his own time, with extra compensation for in some cases the air samples picked up asbestos par- ? each car undercoated. The location of the operations tides surrounded by an asphalt coating. j varied at the different agencies. In most cases a sec Additional information about the health of cer- j tion of the garage area was set aside for the opera tain individual operators was obtained. At establish- tion, which might be performed in an open area or meats where at least 150 cars were undercoated an- segregated from the main repair operations by means of canvas curtains used to prevent the material, nually it was recommended that an x-ray film of th-r j chest (14 by 17 inches) be taken of each employe--' ' during spraying, from lodging on other automobiles in the area. About 25 per cent of the agencies had separate workrooms used exclusively for this opeiation. T he undercoating material was usually re ceived in 55-gallon drums and dumped into 275-gal lon storage tanks. Under a pressure of approximately engaSc<^ *n tills operation. In some establishment:' arrangements were made with the local health uni; for free x-ray studies; in others, the expenses wet-' underwritten by the employer. Twenty-five of the employees involved had such films taken. All x-:vstudies were interpreted as negative. 100 pounds per square inch the mastic material was forced through a spray gun of the type used in spray Discussion painting. Parts of the automobile that were not un dercoated were protected during spraying by mask ing tape. The wheels were removed, and the automo I he observations here recorded raise the quest; ' whether the use of an undercoating material conta-t mg asbestos had a direct relation to the clinical an-