Document qd2mXNq1ZYyRvjB7yJe87Vj75

FILE NAME: WR Grace (WRG) DATE: 1937 DOC#: WRG239 DOCUMENT DESCRIPTION: 1937 Journal Article. Copy of WRG022 with note regarding absence in WR Grace own files. New England Journal of Medicine - Vol 216 Issue 4 - Dangerous Dust - pages 162-165 j.uf.a,. DANGEROUS DUSTS* BT JOHX B. BUVT13, lXD, iiJJ.f TH E subject on which I am to speak is im Another case was that of a man who had. portant for two reasons. In the first place, veloped tuberculosis. Ha had worked as sent this question of dust, dangerous or otherwise, of cotton cloth with scissors and with a _ constitutes the moefe important problem in the whole field of industrial medicine and, second ly, dust is the source of one of the most -ricious " rackets" inflicted o n th is country. This latter I will describe briefly. The basis of this racket is founded on (1) ig norance on the part of the workingman, (2) ig norance on the p a rt of doctors as to what dusts are dangerous and (3) unscrupulous and mer cenary lawyers. The average workman is well in one of the most high-grade private charitable enterprises for the handicapped that I hutc-vii in Boston. He was under the care of a will known and competent physician. In going < the files of this case I read a letter fra tphysician to the effect that his patient'si to this cotton dust, inhaled in the course o;I work, might well have led to pneumoconiosis i should therefore be considered a possible ea of his tuberculosis. Naturally, I had inspect aware that the granite cutter, who has been ex the premises where this man worked and posed to granite dust and has been disabled that the dust was conspicuous by its absence.! thereby, quite properly receives compensation, as that the quarters were light, airy, clean and ' does the sandblaster and, in many instances, 'he ventilated; by.no conceivable chance cooliLtbc foundry worker. Naturally, the laborer is in no dust have been in any way a casse of his position to make a distinction between the vari ous varieties of dust, innocuous or dangerous. All dusts look alike to him. Therefore, if in the course of his work in a lime kiln, & textile fac tory or flour mill or elsewhere, be comes down with bronchitis, bronchiectasis, asthma, tubercu losis or something similar, he very natnrslly These are examples of what I believe ^ . ignorance on the part of physicians desirmg^S help out their patients. The following ease^T rather different. A man in a certain very lair industry in this country m ar be exposed in { course of his work to minimal amounts of r o t t i iron dust, which is beneficial .rather than argues that it was the dust that caused it and !fui, equally minimal amounts of lime, ms damages. This brings us to the second contains a microscopic amount of a ha _ reason for this racket, which is likewise based on silicate (lime in fact is often advocated in treat ignorance--ignorance on the part of the medi meat) and some powdered soap^ one of the: 3 cal profession as to what constitutes a dangerous gradients of which is a silicate, perfectly her dust and as to the difference between the general less in such minimal quantities:--The powdero3j term, pneumoconiosis, and the specific one, sili- soap is used for lubricating iron or steri winT1 co3is. Of the many physicians whose testimony as it is drawn through a die. I t should be bor I have listened to in such cases I know of only in mind that this soap was a lubricant and in no one that I feel is actuated by mercenary mo way an abrasive, as an abrasive soap would ban tives for testifying as he does. In the vast ma ruined the wire. The physician I have in mind jority of instances of this kind, doctors are testi testified in five of these cases, in which I * fying for their clients with honest and sincere wise appeared. In one case the autopsy shows motives. A few examples of this might well be that the man had died of cardiorenal given hero. " . with no trace of silicosis in his longs, but itwa A physician, whom I have known for 30 years claimed that the man had had silicosis and that as an intimate friend and a high-grade general this was responsible Iqc his death. His _ practitioner, testified in my presence that a cer mony in the other cases was along similar linen tain man who had been working in a woolen Of this nothing further need be said. ' ' J"= mill had acquired a chronic asthmatic bronchitis because of Uxe dust to which he was exposed in the course of his work. He had never inspected the mill itself. Aside from the fact that wool dust is perfectly innocuous and never has caused any serious disease, I personally had inspected this mill which was situated in one of the sub urbs of Boston and had found the conditions there to be^the most hygienic that one coaid ex pec^ There was practically no dust. The third factor, and the most important one in th development of this racket, is the croni " and mercenary attorney. One of .the very la industries in this country, that of cement making, where workers may be exposed to one the harmless silicate dusts, has been subject to attacks on this basis with the result that " diets of 115,000, $20,COO and $25,000 have awarded to the plaintiffs, with cases saidirtaj amount to over $12,000,000 now pending! Clev* b*for* til m m tin f ( tlH .Vm-rtcaa Clinical and lawyers with able assistants, a `hired group1 Citlstm.alh>iaal Aaaoelntlaa m Rldunand. V irginia. O ctotnr i f , witnesses and unscrupulous physicians were abE fKawcn. Ja k a H.. la d --P w ld e e . Boaiaa Tufcnwnlnal I j m . to carry on this remunerative occupation fort1, ciatira. F o r11n*e. r d .and addrasn o< a u iao r m --Tfcia W M k'i very long time befor* the manufacturers crisi W. R. Grace & Co. received this document on July 27, 1985, from the plaintiff as a trial exhibit in Greenville County School Dist. v. 0. S. Gypsum Co., et al.. C/A No. 82-3142-14 (U.S.d .c . South Carolina). No I i copy of this document has been 1 1 found in Grace's own files. PLMNW'S EXHIBIT Z&O?./ - 'V - vac. r.* .*: y o . * _ _________ __ DA^CS&OCS DC3TS-- H aw SS . 163 --------------------- . ' jSS* C ^ .. btne<l resources to defeat these So much for one aspect of this question. . Kow I return to my subject, " dangerous dusts." The title is b it of a misnomer os there is only on* dust th a t may be dangerous and that is the* dust which contains silicon in some form. All the organic dusts and those inorganic dnsts which do not contain silicon are harmless. Lest there be a storm of dissent from those who wish to contradict me when I make this statement, may I first define the word, " dangerous" , as 'need here.' By " dangerous" I mean a dust that, either by itself or in combination with some thing else, injures or irritates the lungs or leads to a fibrous tissue reaction which reduces the individual's resistance to tuberculosis and other bacterial diseases of the respiratory tract. N at urally, I do not include chemical, poisons. Let ns first consider the organic dusts. Street dust, although it may contain small amounts of silica, in itself is harmless. The only danger in curred in breathing street dust comes from the germs that may be present, especially in winter. There has been a great deal of loose writing about the danger of organic dusts. For many years the high mortality among the workers in tobacco factories was notorious and was blamed on tho d n s t . The truth of the matter is that tobacco dust is not dangerous but that the work involved in this industry called for little or no physical exertion and. therefore, invited weak lings, while, in addition, the hygiene of the work ers was notoriously low. Consider the textiles, <*otton and wool. Anyone going into the sort ing room of either a cotton or a woolen mill will usually find the air full of dust. Here the hales of raw material are opened and the conrents " fluffedup" , as it were. Armfuls of the cot ton or wool ore then put down an immense chute by the workmen, where it is carried on to the next department. In the majority of instances, anyone entering this room for the first time, un less he is absolutely nonallergic, will soon notice a tickling of bis nose and a 3trong tendency to rub or scratch that organ and, sooner or later, will experience some sneezing. Strongly allergic persons will have this to a marked degree. Cer tain individuals of this type often come down with a severe acute rhinitis or a bronchitis dur ing the first 10 days or so of their work in the 'wring room, which soon passes off, however, [vine no ill effects. All this does not mean that wo-il or cottomdust is dangerous in the slightest. Ard ret one of the most marked cases of silicosis fhat I ever saw- was in a workman whose job for mnny years had been in the sortiug room of a b'rge factory where woolen carpets were made. A large part of the raw material in this room rntne from Egypt or some other foreign saad r -'trier. Amazed at finding silicosis in a wool worker when I knew that wool could not be the we. I investigated the plant and in this room found an eighth to a quarter of an inch of brown desert sand os the floor, some of which, is the course of the work, wqs of necessity breathed in--hence, this man's.silicosis. . Another marked ease of silicosis occurred in a man who had worked fo r many yean in the W alter Baker Chocolate Factory in MUtoa, and yet chocolate and cocoa dust are certainly in* nocuous enough. This m an's sole job, I found on investigation, was to resurface the granite mill wheels used to grind the cocoa bean. A n-. other very marked, and eventually fatal case of bronchiectasis occurred in a worker in a large lumber mill where every workman was exposed to varying amounts of wood dust. In this case,' however, the man fell down a chute into which sawdust was poured and was taken out, uncon scious, an hour later from the mass of sawdust which had boried him. Here again there is nothing to prove that wood dost is harmful. And so I might go on through all the organic dusts. . Now a word about the non-sflicon-containing inorganic dusts. The worker ir the soft coal mine develops anthracosis, which shows up strik ingly on an x-ray,, b u t.it is not a disabling dis ease, nor does it predispose him to tuberculosis. zo c A oo| -- n s0 C J<Zo -*- w <t s "4 -U 3 OS o> ^c 3c a S C o O 3 . c 8." U <0 2o a 0e W -t u jB O O C 44 -4 a <o|. j >o 1 we Qi 3 o|--s oU oW I f he gets silicosis, as some of the workers in the hard coal mines occasionally do, it is be cause of the granite or silieon-cdbtaining rock in which the coal is imbedded. I haveno doubt but that the slate and marbl-rworkers will pre sent changes in their lungs after years of" ex posure to this dust, but such exposure certain ly does no harm. Exposure to lime even seems to do good. Granted, then,--- I feel sure that many of you will not grant it--that the only dangerous dust is the one that contains silicon In some form, what are the factors that determine the degree of danger in the exposure to such siiicou- containing dusts? These may be given as fol lows: * * (1) The amount or proportion of silica presmt in the dust. Silicon is such a cbm- JS a -U < XO rO4 2l . > < -4 o1 0 -4 I O I w as oo 14 -u > <N Vc a 3o *"4 IQ u 3344 o 4 4 1-4 O aU u cH >c O <0 -4 O 1 o Q, u o , St c mon element that it might be said to be ' ubiquitous. I t is present in small amounts in practically all street dust. The stiff ness of the fibers in hay, straw and cere als and that of the feathers of birtb.'fls* due to silicon. I t is a normal constituent of lung ash up to 1 per cent. I t is only when it is present in excessive amounts, such as in granite dust and sand, which are nearly pore silicon, that it constitutes a menace. - . . (2) The form of siUcon present `in the dust Free silicon, SiO-, as found in granite and sand, is infinitely more dangerous than combined silicon, as found in the silicates with one exception--asbestos. 164 DA-VGER0C3 DCSTS-- H A W E - ' x. e. i. o i TAX St w t- \i . 4 ' Except for asbretne the silicates may be do not take the statement of the patient or described as comparatively harmless. of his friend's or, indeed, of his family phj Consider talc, for instance, ta lc . a. mas- eian entirely for granted, but that, where _ ncsiiim silicate, is the basis of almost all possible, you go through the plant and see.fai toilet powders and is used extensively in ;'ourself the exacts work that the man or the rubber industry. It rarely, if ever, (lid and how much actual dust he or she ' has been known to cause a disabling fibro exposed to in the course of said work. This, oj sis in the lungs. course, does not mean th at you must take ,.(:j) The ire of the dust particle. Particles dust count or make a chemical analysis, wl of less than 5 microus are most? danger should be obtained from experts, but it d< . oos. Particles over that size do not enter mean using one's common sense iu sizing into the finer tissues of the lungs aud are, the situatiou. The second point to be conside therefore, practically innocuous. The rate in making a diagnosis concerns the sympt of the fibrous reaction in the lungs is The mo3t striking of these is shortness of brea proportional to the fineness of the dost. cough may be, bub often is not, present, wi oss of weight and strength, blood-spitting (4) The density of the dust. If the number general weakness are often conspicuous by t; of particles of silicon-containing dust per absence. Shortness of breath by itself, wii cubic foot of a ir1exceeds twenty millieu out any other condition to explain it. is an is sneh a dust may be said to be dangerous. sortant point. (3) Intensity of the exposure.* The granite Third to be considered are the physical n\ cutter working with a surfacing machine iu the lungs. These, again, may be conspicuous^ is exposed to infinitely more dust than the absent; but, in well.advanced cases, gene * foundry worker, who is only occasionally did ness, most marked at the bases and extea iu certain types of work exposed to much ing upwards, front and back, harsh, prolong dust. A survey in Massachusetts showed a and often diminished expiratiou aud occasion . . silicosis incidence of 15 per cent in grnn- fine, high-pitched rales, as if tw j pieces o . ite cutters and only 8 per cent in foundry fine sandpaper were being rubbed together, aw workers. . importane to bear in mind: I n `addition to the (6) Length of the exposure. I t naturally fol signs there is one on which I am coming .ti lo w that the longer the exposure the place much importaxfce, namely, a marked ' greater the inhalation of dust. An ex striction of chest expansion on taking a dee. posure of 12 to 15 years is the average breath. This is especially true itf alestos work time required to give a granite cutter a ers. I have seen nearly 7_meu._and worm disabling silicosis, while oue of 2 to 3 that have been exposed fo'asbestos dust an years can cause it among asbestos work have found that the one striking sign presec ers. in those in whom I have made a positive diag nos has been a greatly diminished chest expan (7) Finally, and I might cail this the most sion, rarely over one inch. One man of nearly important factor of all, we come to that 70 years came in to see me who had work indeterminable questioa, the individual for many years in this particular factory as resistance to dust. Just as certain persons night watchman and who by the very uain are extraordinarily resistant to tubercu of his work had been exposed to little or n losis, so are others, for no known reason, dust. He had marked arteriosclerosis and co able to breathe in large amounts of a siderable emphysema and complained of shin dangerous dust over a long period of ness of breath, but nevertheless he was able ti time without damage to their lungs. expand his lungs nearly three inches. X-ra; Each one of the above points must be taken showed normal longs except for a modem into account. Bearing them in mind, let us now emphysema. ' consider the diagnosis, of silicosis. This has been left far too long entirely in the hatuls of the roentgenologist. If the x-ray man iu conrt or at the clinic says that the plate show ii dif fuse, nodular fibrosis and makes a diagnosis of silicosis, no other factor pro or con. up to the present time, is apt to be given serious consid eration. T object strongly to this. Finally, we come to the x-ray. This, in ad; vanced cases of granite cutter's silicosis or tb of the sandblaster or indeed in well-marked n bestosU, speaks for itself. The borderline <$> however, are very difficult to decide upon, much so, that I know of no two x-ray men wb would agree. Of course, the presence of complicating tuberculosis, with a history of The diagnosis of silicosis, just as the diagno posare to a dangerous dust and even slight sit sis of tuberculosis, depends upon various fne- in the lungs physically or by x.ray, would tern 'ors, the first of these being the history of ex to justify a positive diagnosis, which withou posure. Whenever you are called to give an three would be impossible. - opinion upon such a case, I would beg that you Asbretosis is a relatively new disease, co mi at ove: -dsh hat .huts nu h-llgt *1 ta* I join.* A-lfc* -a\* it- c -.f fa :y ili r. w. R. Grace & Co. received this document on July 27, 1985, from the plaintiff as a trial exhibit in Greenville County school Diet, v . u . s . Gypsum Co.. ' et al.. C/A No. 82-3142-14 (U-S.D.C. south Carolina). No copy of this document has been found in Grace's own iles. PLAINTIFF'S \& ) IVI- l* EVALUATION Or ULTRAVIOLET THERT--8UXKER ANO KARRIS 165 N'. _ , which we know remarkably little except cept under prolonged, intense exposure along mw fcctoa not seem to correspond to the laws with a very g rey ly lowered individual- resist* 'iwemin? licwis in general. Tlwr- is not the ance. ji'-Ut-st doubt, however, in my mind at least, The points emphasized in this brief talk ou *litt asbestos dust is the most dangerous oi all a very big subjeet are the following: .{lists. Asbestosis is able to produce total and .*.nuan*'Ut disability in a remarkably short .titftli of time, even after only 2 o r J years' ...<q5!iir* and occasionally less, as compared with iiie much slower and more gradual action of i.ure silicon and the great majority of silicates. A.ta re s is an alnminum or magnesium sili- or a combination of these or others and. in (1) That there Is only one dangerous dost-- that containing silicon in some fo ra ; . (2) That the diagnosis should be based, not purely on x-ray, but on a history of ex* posure, on the clinical symptoms and on the signs in .the lungs, along with the x-ray; and, . > oltrinical analysis, agrees closely with that ..f talc, cerneut and certain other silicates. The fart remains, however, that asbestos is extreme (3) That, whenever possible, a personal in spection of the claimant's work should be made in order to see for one's self jus: ly iluug-rons and fatal, while talc, cement and how much dust exposure there is thus in .a lew .silicates are comparatively innocuous ex- suring a correct and fair decision. PRECISE EVALUATION OF ULTRAVIOLET THERAPY IN EXPERIMENTAL RICKETS* . u r joux \v. it. bunker, pn.D.,t and robert s. Harris, ru.D.f IN*a. previous communication, ris` recorded the opinion Bunker and Har that light radia- mom* of wave lengths other than those in the r-.-iou. 2*00-3100 Angstroms, which at that time v.wi* generally regarded us constituting a " vital handicap of the filter method is the difficulty of eliminating longer wave lengtlts while retain ing shorter, since increasing absorption Is gen erally first obtained at shorter wdve lengtlw. .Another difficulty lies in the J a c t- that swh filters do not cut oil sfaarpfy, but generally of light, may assist in the biochemical allow definite increments of longer or shorter |.r-vvci of rickets therapy. This opinion, based wave lengths to he present in a selected band, ti .rHiminary qualitative studies, was strength- which increments must always be of unknown by the findings of Sonne and Rekling,* who relative importance, if in fact there be a differ 2.130 to 3025 as an antirachitic region. ence in the relative effectiveness of various wave since 1030 but few reports bearing upon this lengths. -itl.jivf have appeared. Knudiion1, * reported By the filter method it was determined that a and prevention of rickets in rats by radia* band made up principally of light from two ^ M-tis fnnu either a quartz mercury vapor arc lines of the mercury arc spectrum, namely, 3023 r *Vi*m a GE S-l bulb and defined the gram and 3130 angstroms, showed some therapeutic ' 2 - of these heterogeneous radiations jieves- value in experimental rickets in rats. Subse- trv to cure a rat whose skin had been depilated. quently, by the use of a water-cell monoclirom- * u N" utctnpt was made to evaluate different parts ator. described by Harrison,4 we were able to 0 tit.- s|i^vtnim. Gorter2 reported that only eliminate from further consideration the line, -`v' r* to 3100 Angstroms are active. Knudson 5130, which was completely ineffective at an ap- 3 `i-t tb-nriwd7 reported in abstract form that plied energy of approximately 1.73 gram calories - 'itimehitic effectiveness of monochromatic per rat. . .jir.i--**.|,*t light does not correspond to that pro Alt the subsequent work was done with a ,, -2> ; '.M.' twytliMiua, but details are lacking. Bausch Lomb quartz monochromator (type "n own ^tudy, continuing with optical filters Xo. 33-66-05) with pristns S cm. by 8 cm., which ' 'i'inI .la.Mies, quartz and solutions of nickel transmits sufficient energy from a 6 iuch. 220 " d copper sulfate, enabled ns to investi- volt Uviare to permit treatment of rachitic rats M'Offrul zones of decreasing width. One with single lines of light. . 0: .l<N(taM K**rn.'A L ab o rato ri* ,. U aaM chaM tU Exprim*ntcl . ' * T--sr'iiiHrr. tu* y. j | fro m tu D -o a n m --ic - f OMUxr a** The arrangement of the equipment used in" i- .Uh. M .m fcirftuwita InatU ui* ec T<>Baloy. Cam. it the phase of the investigation dealing with '' l-' .Wi..W .--<-Onirn-eMtoran( tBlaimlaiarirwai-iW.m.M.arrrft.t 1L1-b,o.. monochromatic radiations is thown in figure 1. - Ii.i.v;;. n t TKbanl o r. Ha rria. Rb*rt .1-- In a white trausite housing, B, open *at top m IS V,T UBBM rnuaM ta Iobciiui* o< Toiwiokorv. ,B : - B ir r a , ( aa tB a ra m "TBib VI'-*' I*.'* and bottom and raised from the bench on legs, n vertical 6 inch Uviare, A, was placed in the p l a in t if f e x h ib it M '