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S T 0 0 6 I105 PLAINTIFF'S EXHIBIT system comprises a great potential source of information about the relative importance of the various hazardous substances encountered in the workplace. Of perhaps even greater importance, the system offers a potential for uncovering exposure-effect relationships not previ Respiratory Tract ously identified as significant. One such relationship which recently became apparent is that of respiratory tract irritation from exposure to fibrous glass. Irritation from During the past several years, there have been a num ber of reports published which discuss the effects of fi brous glass2'5 upon the lungs. The authors of these re Fibrous Glass ports have been primarily concerned with the possibility that inhalation of finely divided particles of fibrous glass may produce fibrotic pulmonary disease. The weight of Inhalation evidence derived from these investigations seems to indi cate that neither in the experimental animal nor in the occupationally-exposed worker is inhalation of fibrous glass particles likely to produce permanent lung changes. Having no relevant information, the authors cannot THOMAS H. MILBY, M.D. comment upon the relationship between fibrous glass in' iiution and pulmonary fibrosis or permanent pulmo C. RICHARD WOLF, M.D. nary damage of any kind. Attention should be focused, however, on one health aspect of fibrous glass exposure which, although well-known among fibrous glass workers, has not been reported elsewhere, apparently having been obscured by scientific concern over more serious pulmonary disease. This problem is respiratory tract irritation which is sufficiently serious to compel the worker to seek medical attention, and is character ized by one or more of the following: bronchitis, rhini tis, sinusitis, pharyngitis, and/or laryngitis. In California, during the period extending from Janu ary I960 to June 1962, 691 cases of occupational dis ease were attributed to fibrous glass exposure. Of these, 38 were primarily problems of respiratory tract irrita tion; the remainder involved the effects of fibrous glass on the skin and eyes. These cases were summarized in an internal health department document, and the original reports discarded. During the interval between June 1962 and September 1967, no special summarization of reports of occupational disease attributed to fibrous glass exposure was compiled. The original reports re ceived during this period have also been discarded. Re Each year in California physicians report some 30,000 cases of occupational disease. Despite maining available for study are reports received from September 1967 through September 1968. During this problems of under-reporting, incomplete reporting and,13-month period, 28 reports describing adverse respira on occasions, inaccurate reporting, the sheer weight of tory reactions to fibrous glass were received. In all, then, 30,000 case reports, received from nearly as many physi 66 reports of respiratory tract irritation attributed to in cians practicing in almost every part of California, can halation of fibrous glass were received during these two not help but yield valuable clues to the understanding of periods. occupational disease diagnosis.1 Taken as a whole, the Among the 66 cases were eleven females and SS Dr. Milby and Dr. Wolf are from the Bureau of Occu pational Health and Environmental Epidemiology, Cali fornia Department ofPublic Health, Berkeley, Calif. males, ranging in age from 17 to 68 years. Occupational designations indicated that cases occurred primarily in individuals who worked directly with fibrous glass or fibrous-glass-bearing plastics, especially where a dusty Journal ofOccupational Medicine 409 ST006 I 106 Rtspintory Tract Irritation Fibrous Glass TABLE I RESPIRATORY MANIFESTATIONS ATTRIBUTED TO FIBROUS GLASS EXPOSURE (A Summery of 66 Case reports) Times Reported Total % Reports Bronchitis**1 Pharyngitis**** Rhinitis*0* Asthma*^* Laryngitis** Sinusitis*** Nosebleed*0* 42 25 20 6 '4 3 1 64 38 30 9 6 5 - (a) Bronchitis: reporting physician's diagnosis or patient com- plained of chest pain and trouble breathing. (b) Pharyngitis: reporting physician's diagnosis or patient com- plained of sore throat. (c) Rhinitis: reporting physician's diagnosis or patient com- plained of pain in nose. Id) Asthma: reporting physician's diagnosis. Id! Laryngitis: reporting phy .ician's diagnosis. (f) Sinusitis: reporting physician's diagnosis. (g) Nosebleed: patient's description. SOURCE: California Department of Public Health operation such as cutting, sanding, or machining was in volved. In addition, however, a number of case reports described individuals who merely worked in the general area where fibrous-glass-containing dust was being gener ated. Thus, it appears that working with the material is by no means the sole criterion of exposure. On 19 of the 28 case reports received during the peri od of September 1967 through September 1968, a nota tion was included which indicated that a chest roentgen ogram had been taken. This information on the 1960-1962 reports is not available. Of these 19 reports, 13 were accompanied by some statement of roentgenographic evaluation. These 13 included nine negative re ports, one "bronchitis," and one "pulmonary fibrosis." The physician who reported this latter case expressed some doubt that the observed "pulmonary fibrosis" was related to the patient's fibrous glass exposure. Table 1 summarizes the respiratory tract manifesta tions noted on the 66 reports. ~ Three of the 66 cases resulted from the same ex posure, and were reported by a practicing occupational medicine specialist. Case Reports Case 1. This 48 year old male maintenance employee worked several 8-hout/ shifts, removing fibrous glass insulation from around a steam pipe. He wore no respiratory protective device, even though such equipment was available. His chief complaints were sore throat, congested nasal cavities, pain in the larynx, and skin irritation. Physical examination revealed no ear, nose, or throat abnor malities, and the skin was dear. The chest x-ray was reported u normal. The physician's impression was that there were minor irritations of the respiratory tract from fibrous glass dust. When the employee began to use the respiratory protective device pro vided, the respiratory irritation lessened, but the itching and irri tation of the skin continued. Case 2. This 27 year old male maintenance employee worked several 8-hour shifts without respiratory protection, removing fi brous glass insulation. Mis chief complaints were a cough and an inability to sleep because of itching. The physician's examination revealed a slight injection of the pharynx. In addition, the nasal mucosa was red and crusted. There were slight rhonchi in the lungs, which cleared on cough ing. A chest x-ray was reported as having prominent markings in the left lower lobe which were probably vascular and within the limits of normal. The employee's symptoms abated after he be gan wearing a respirator. Case 3. This 34 year old male supervisor was in the area with out respiratory protection, directing the removal of fibrous glass insulation, for three 8-hour shifts. When he came to the dispen sary, his chief complaints were persistent throat irritation, cough, and a burning sensation in the throat. He reported along history of sinusitis, allergic rhinitis, and asthmatic episodes occu rring in the past as a result of ingestion of chocolates and other foods. There was no asthma attack with this work exposure. The physician's examination revealed some rhonchi in the left lower lung field. A chest x-ray was interpreted ai normal. The symptoms were gone the following day. Conclusions Although these reactions to fibrous glass do not, to our knowledge, result in permanent disability, the au thors believe such reactions are nonetheless noteworthy because they indicate that fibrous glass is a substance which is fully capable of causing symptomatic respira tory irritation. Therefore, the following recommenda tions would seem to be in order: 1. Workers should be protected from respiratory exposure to airborne fibrous glass by accepted industrial hygiene practices. Reliance on filter- type respirators should be confined to brief ex posure situations. 2. Further studies should be undertaken to define more clearly the health hazards associated with exposure to airborne, fibrous glass-plastic mix tures. 2151 Berkeley Way Berkeley, Calif. 94704 References 1. BERKOV, B. M.; KLEINMAN, G. D.; POWERS, J. E.; and TRASKO, V. M.: Evaluation of Occupational Disease Re porting in California. J Occup Med, 3:449, 1961. 2. NASR, A. N. M.: Pulmonary Hazards from Exposure to Glass Fibers, J Occup Med, 9:345, 1967. 3. WRIGHT, G. W.: Airborne Fibrous Glass Particles. Chest Roentgenograms of Persons with Prolonged Exposure. Arch Environ Health, 16:175, 1968. 4. INDUSTRIAL HYGIENE FOUNDATION of AMERICA, INC.: A Report on Health Aspects of Fibrous Glass. Med Series Bui, No. 13-68. 5. SCHEPERS, G. W. H.: The Biological Action of Glass Wool. Arch Indust Health, 12:280, 1955. 410 August 1969 Volume 11 No. 8