Document wq5prqj7EYzrYKx7pL8kxgN4o

FILE NAME: WR Grace (WRG) DATE: 1937 DOC#: WRG022 DOCUMENT DESCRIPTION: 1937 Journal Article - New England Journal of Medicine - Vol 216 Issue 4 - Dangerous Dust - pages 162-165 ' *.l ./- : / '? . ,, , 1i .. ... . 162 .fe r- D.OEROU3 DU3TS-- UA1VE3 'fa-VAi; N. E. / ; o r J ja-v_a,, lu DANGEROUS DUSTS* BT JO H N B. HAWES, 2 ND, ^PH E subject on which I am to speak is im- Another case was that of a man who hod d 1. portant for two reasons. In the first place, veloped tuberculosis. lie had worked as a entte this question of dust, dangerous or otherwise, of cotton cloth with scissors and with a constitutes the most important problem in the in one of the most high-grade private ch aritab ly whole field of industrial medicine and, second enterprises for the handicapped that I knaw. of ly, dust is the source of one of the most vicious in Boston. He was under the care of a we) " rackets" indicted on this country. This latter known and competent physician. In going ovVj .1 will describe briefly. . ' - the files of this case I read a .letter froo-thi The basis of this racket is founded on (1) ig physician to the effect that his patient's exposure? norance on the p art of the workingman, (2) ig to this cotton dust, inhaled- in the course ot;Ki ' . norauce on the p art of doctors as to what dusts work, might well have led to pneumoconiosis an are dangerous and (3) unscrupulous and mer should therefore be considered a possible ca cenary lawyers. The average workman is well of his tuberculosis. Naturally, I had inspeci. aware that the granite cutter, who has been ex- the premises where this man worked and kne "posed to granite dust and has been disabled that the dust was conspicuous by its absence ant thereby, quite properly receives compensation, as that the quarters were light, airy, clean and we . does the sandblaster and, in many instances, +he ventilated-; by no conceivable thonce couldth_ _ , foundry worker. Naturally, the laborer is in no dust have been in any way a cause of his illnesSsS position to make a distinction between the vari These are examples of what I believe tosi> " ous varieties of dust, innocuous or dangerous. ignorance on the part of physicians desiringita ' AU dusts look alike to bini. Therefore, if in the help out tlftir patients. The following ease* course of hi3 work in a lime kiln, a textile fne- rather different. A man in a certain very large torv or dour mill or elsewhere, lie comes down industry in this country may be exposed in: the with bronchitis, bronchiectasis, asthma, tubercu- course of his work to minimal amounts of rasribi losts or something similar, he very naturally iron dust, which is beneficial rather than hariS . argues that it was the dust that caused ifc.and f u l , .equally minimal amounts of lime, whfclSsI ! . claims damages. This brings us to the second contains a microscopic amount of a harmless*^? reason for this racket, which is likewise based on silicate (lime in fact is often advocated in treatSS^ ignorance--ignorance on the part of the medi ment) and some powdered soap, one of the:inS|a cal profession as to what constitutes a dangerous gredients of which is a silicate, perfectly harass? . dust and as to the difference between the general less in such minimal quantities:--The powdered^ terra, pneumoconiosis, and the specific one, sili soap is used for lubricating iron or steel wir'eSi " cosis. Of the many physicians whose testimony as it is drawn through a die. I t should be boraeqa I have listened to in such cases I know* of only in mind that this soap was a lubricant and ia o*2. one that I feel is actuated by mercenary mo way an abrasive, os an abrasive soap would haveas? tives for testifying as lie does. In the vast ma ruined the wire. The physician I have iamiod^S jority of instances of this kind, doctors are testi testified in" five of these cases, in which 1`lik^a-^ * fying for their clients with honest and sincere wise^appeared. Jn one case the autopsy showed^ ' motives. A few examples of this might well be that, th? man had died of cardiorenal disesseiX given here. with no trace of silicosis in his lungs, but it;wa'sjfe A physician, whom I have known for 30 years claimed that the man had had silicosis and.thit?^ as an intimate friend and a high-grade general this was responsible ffir his death. His practitioner, testified in my presence that a cer mony in the other cases was along similar lines^? tain man who had been working in a woolen Of this nothing further need be said. , mill had acquired a chronic asthmatic bronchitis _ The third factor, and the most important^neS. " because of the dust to which he was exposed in in the development of this racket, is the crookcdfe' the course of his work. He bad never inspected and mercenary attorney. One of .the very la rg t^ the mill itself. Aside from the fact that wool iudustries in this country, that of cement^1 - dust is perfectly innocuous and never has caused making, where workers'may be exposed to onaohSi any serious disease, I personally had inspected the harmless silicate dusts, has been subjected^; this mill which was situated in one of the sub to attacks on this basis with the result that verfji urbs of Bostou and had found the conditions diets of $15,000, $20,COO and $25,000 have betalj there to be the most hygienic that one could ex awarded to the plaintiffs, with cases said-doJ^ pect. There was practically no lust amount to over $12,000,000 now peiul-op! Clcv^r^j b efore th e m*#tiv *r th * A m erican C lin ic a l a n j lawyers with able assistants, a hired group-of,^- C1lim.a to lo g ic a l A is o c la tlo n KlcUmumf, V irg in ia, O cto b er -7 . - witnesses and unscrupulous physicians were ab[e| f l f a n v . J o h n II.. J nU-- Hor t on T u b e rc u lo sis Ah o > to carry on this remunerative occupation f o r y ^ e la tio n . F o r reco rd a n d otiti* o f a u th o r Is s u e /* p i c * ISO. ~ ` "T hla W eek very long time before tli^n an u factu rex ^ P LA IN T IFF'S EXHIBIT ,2 1 is Tl; ali *. a :-I.S r i t.h a ;i:v. ;!: y. i.i*v i-r. .M l I '._ !.p... ' ii .. !<y il n-\i TIH'.-1 i. a r>:li , " :!1 . I-IN..I ;-nii ; `Uh ; in- if Hi ' ' ill "".I An l v - -I " HU 1 far*. ' ..in.. , Mri.-i '' il.-r *-"l*!4 v oi~ : u '* - - m * '* i . 7 . d a n g e r o u s d c s t s --h a w e s - " - ' - ' 163 Lined resources to defeat them. So much for one found an eighth to a quarter of an inch of brown . aspect of this question. . desert sand on the floor, some of which, in the Now I return to my subject, `'dangerous course of the wqrk, was of necessity breathed dusts." The title is a bit of a misnomer as there in--hence, this man *3, silicosis. . is only one dust that may be dangerous and that Another marked case of silicosis occurred in a is the dust which contains silicon in some form. man- who had worked for many years in the All the organic dusts and those inorganic dnsts W alter Baker Chocolate Factory in Milton, and which do not contain silicon are harmless. Lest yet chocolate and cocoa dust are certainly in there be a storm of dissent from those who wish nocuous enough. This man's sole job, I-found to contradict me when I make this statement, on investigation, was to resurface the granite may I first define the word, " dangerous" , ns mill wheels used to grind the cocoa bean. An used.herc. By " dangerous" I mean a dust that, other very marked and eventually fatal case of either by itself or in combination with some* bronchiectasis occurred in a worker in a large thing else, injures or irritates the lungs or leads lumber mill where every workman was exposed to .a .fibrous tissue reaction which reduces the to varying amounts of wood dust. In this case,' individual's resistance to tuberculosis and other however, the man fell down a chute into which bacterial diseases of the respiratory tract. N at sawdust was poured and was taken out, uncon urally, I do not include chemical poisons. scious. an hour later from the mass of sawdust Let ns first consider the organic 'dusts. Street which had buried him. Here again there is dust, although it may contain small amounts of nothing to prove that wood dust is harmful. silica, in itself is harmless. The only danger in And so I might go on through all the organic curred in breathing street dust comes from the dusts. . . . germs that may be present, especially in winter. Now a word about the non-silicon-containing There has been a great deal of loose writing inorganic dusts. The worker ir the soft coal about the danger of organic dusts. F o r many mine develops anthracosis, which shows up strik years the high mortality.among the workers -in ingly on an x-ray, but it is not a disabling dis tobacco factories was notorious and was blamed ease, nor does it predispose him to tuberculosis. on the d n s t . The truth of the matter is that If he gets silicosis, as some of the workers in tobacco dust is not dangerous but that the work the hard coal mines occasionally do, it is be involved in this industry called for little or no cause of tlie granite or silicon-containing rook physical exertion and, therefore, invited weak in which the coal is imbedded. I have no doubt lings, while, in addition, the hygiene of the work but that the slate and marble-workers'will pre ers was notoriously low. Consider the textiles, sent changes in their lungs after years of ex _ `-otton and wool. Anyone going into the sort posure to this dust, but such exposure certain ing room of either a cotton or a woolen mill ly does no harm. Exposure to lime even seems will usually find the air full of dust. Here the to do good. j* ' hales of raw material arc opened and the con Granted, then,--I feel sure that many of tents " fluffed u p " , as it were. Armfuls of the cot you will not^grant it--that the only dangerous ton or wool are then put down an immense chute dust is he one that contains silicon In some form by the workmen, where it is carried on to the whet arc the factors that determine the degree ` next department. In the majority of instances, of danger in the exposure to such silicon- anyone entering this room for the first time, un containing dusts? These may be given as fol less he is absolutely nonallergic, will soon notice lows: . a tickling of his nose and a strong tendency to rub or scratch that organ and, sooner or Inter, (1) The amount or proportion of silica pres will experience some sneezing. Strongly allergic ent in the dust. Silicon is such a com ptrsons will have this to a marked degree. Cer mon clement that it might be said to be -tain individuals of this type often' come down ubiquitous. I t is present in small amounts - with a severe acute rhinitis or a bronchitis dur in practically ail street dust. The stiff ing the first 10 days or so of their work ia the ness of the fibers in hay, straw and cere 'r:ing room, which soon passes off, however, als aud that of the feathers of birds, is leaving no ill effects. All this does not mean that due to silicon. I t is a normal constituent wo i] or cotton dnst is dangerous in the slightest. of lung ash up to 1 per cent. It is only Aid vet one of the most marked eases of silicosis when it is present in excessive amounts, that I ever saw was in a workman whose job for stick as in granite dnst and sand, wltich tii.iuy years had been in the sorting room of a arc nearly pure silicon, that it constitute Live factory where woolen carpets were made. a menace. A large part of the raw material in this room otnc from Egypt or some other foreign sandy *i"trict. Amazed at finding silicosis in a wool worker when I knew that wool could not be the (2) The form of silicon present in the dnst. Free silicon, SiO;, as found in granite and sand, ia infinitely more dangerous than combined silicon, as found in the <au<e. I investigated the plant and in this room silicates with oi exception--asbestos. 64 DANGEROUS DUSTS--HAWES ' -i-itj, N. E. J.:Oa>V, JAY. it, u Except for asbestos the silicates may be o not take the statement of the patient or than: . described as. comparatively harmless. of his friends or, indeed, of his family pbvsi Consider talc, for instance. Talc, a mag nesium silicate, is the basis of almost all . toilet powders and is used extensively in . the rubber industry. I t rarely, if ever, V - has been known to cause a disabling fibro* sis in the luugs. clan entirely for granted, but that, whereve possible, you go through the plant aud see.fo yourself the exact, work that the man or wo did and how much nctunl dust he or she w; exposed to in the course of said work. This, o course, does not mean that you must taken , _(3) '* .. (4) The size of the dust particles. Particles of less than 5 microns are most danger ous. Particles over that size do not enter into the Oner tissues of the lungs nud are, therefore, practically innocuous. The rate of-the fibrous reaction in the lungs is proportional to the fineness of the dust. The density of the d u st If the number of particles of silicon-containing dust per cubic foot of air'exceeds twenty milliou such a dust may be said to be dangerous dust count or mnke a chemical analysis, whi__ should be obtained from experts, but it do meau using one's common sense in sizing r. the situation. The second point to be considered! in making a diagnosis concerns the symptom The most striking of these is shortness of bread'" cough may be, but often is not, present, whili loss of weight and strength, blood-spitting ab_ general weakness are often conspicuous by their tbsence. Shortness of breath, by itself, with out any other condition to explain it, is an i portant point. .. (5) Intensity of the exposure. The granite Third to be considered are the physical sigr s cutter working with a surfacing machine in the lungs. These, again, may be conspicuous!? is exposed to infinitely more dust than the absent; but, in well-advanced cases, generalizisiil foundry worker, who is only occasionally dulness, marked at the bases and extern' in certain types of work exposed to much ing upwards, front and back, harsh, prolong . . dust. A survey in Massachusetts showed a anti often diminished expirution and occasional . silicosis incidence of 15 per cent in gran fine, high-pitched rales, as if two pieces o ` . . ite cutters and only 8 per cent iu foundry fine sandpaper were being rubbefl together, ar - workers. * . important to bear in mind. Iu addition to th ` (6) Length of the exposure. It naturally fol- _ lows that the longer the exposure the ` greater the inhalation of dust. An ex posure of 12 to 15 years is the average time required to give a granite cutter a disabling silicosis, while oue of 2 to " years can cause it among asbestos work ers. ' ` (7) Finally, and I might call this the mos ' important factor of all, we come to that indeterminable question, the individua' resistance to dust. Ju st as certain persons . are extraordinarily resistant to tuberen losis, so are others, for no known reason able-to breathe in large amounts of dangerous dust over a long period of _ time without damage to their lungs. signs there is oue ou which I am coming toy* place much importance, namely, a marked reyw l strictiou of chest expansion on taking a deepvjS breath. This is especially true in asbestos work-*j | ers. I have seen nearly 75_meu_aud .women.^ i that have beeu exposed fo" asbestos dust and ( have found that the one striking sign p ro e u n S J iu those iu whom I have made a positive diag-5jf * nosis lias beeu a greatly diminished chest expan-*& sion, rarely over one inch. One man of n early 70 years came in to see me who had worked;' for many years in this particular factory as aj$ uight-'watclnnan and who by the very uaCiircr of his work had been exposed to little o r-n o S dust. lie bad marked arteriosclerosis and cou-rt siderable emphysema and complained of shurU-Sg ness, of breath, but nevertheless he was able .tew expand his lungs nearly three inches. X-ray? ' ' M Each one of the above points must be taken showed normal lungs except for a m oderate^ 'into account. Bearing them in mind, let us now emphysema. ' ' , consider the diagnosis of silicosis. This tins Finally, we come to the x-ray. This, in adlv? been left far too long entirely in the hands vanccd cases of grnnite cutter's silicosis or thatsj of the roentgenologist. If the x-rnv man A court or at the clinic says that the plate shows a dif fuse, nodular fibrosis and inaUes 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. of the sandblaster or ihdeed in well-marked ns-= bestosis, speaks for i`tsel` f`. T- he borderline eases,`V i however, arc very difficult to decide upon, so*? much so, that I know of no two x-ray men wli would agree. Of course, the presence of , complicating tuberculosis, with n history of er-J The diagnosis of .silicosis, just ns the diagno posurc to a dangerous dust and even slight signsS sis of tuberculosis, depends upon various fnc- in the lungs physically or by x-ray, would toml^S \ors, the first of these being the history of ex to justify a positive diagnosis, width withmi*; posure. Whenever you arc called to give an these would be impossible. . v opinion upon such a case, I would beg that you Asbesto.ds is a relatively new disease, cuu r J.HI r.-.-i ;.|> V - I I Jl .nee s; s'dij un- ii-ii-r r ahit sirj-X.i ,i ! It '.VO I ..iid *... . i Ira I'lt-il; "II N" ir.ji '* t| , , 1. voi- :i* st*. t__ EVALUATION* O F U L T R A V IO L E T T H E R A P V --B U N K K R A.\L> H A R R IS 1S5 t^niinu which we kuow remarkably little except lh.-if it does not seem to correspond to the laws governing silicosis in general. There is not the dishtest doubt, however, in my mind a t least, that asbestos dust is the most dangerous of all' dusts. Asbestosis is able to produce total aud ]*rnianeut disability in a remarkably short trin'tli of time, even after only 2 or 3 re a rs ' rtq**>ure and occasionally less, as compared with die much slower aud more gradual action of Imre silicon aud the great majority of silicates. AJh-,u*s ..is an aluminum or magnesium sili,ate or a combination of these or others and. in hs chemical analysis, agrees closely with that ,d tale, cement and certain other silicates. The fart remains, however, that asbestos is extreme ly dangerous raid fatal, while talc, cement and .mI*t silicates are comparatively innocuous ex cept under prolonged, intense exposure along with a very greatly lowered individual resist ance. . ,, The points emphasized in this brief ta li ou a very big subject are the following: (1) That there is ouly one dangerous dust-- that containing silicon in some form; . (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, , . (3) That, whenever possible, a personal in spection of the claimant's work should be made in order to see for cue's self jus: how much dust exposure fiiere is, thus in suring u correct and fair decision. PRECISE EVALUATION OF ULTRAVIOLET THERAPY - IN EXPERIMENTAL RICKETS . .. lr JOHN' \V. II. BUNKER, PU.D.,t A N D ROBERT S. HARRIS, ril.D.f IX a previous communication, m* recorded the opinion Bunker and H ar that light radia- rii.ns of wave lengths other than those in the r-cHii. 2.":00-3100 Angstroms, which at that time vrrr generally regarded as constituting a " vital handicap of the filter method is the difficulty of eliminating longer wave lengths while retain ing shorter, since increasing absorption is gen erally first obtained at shorter wave lengths. Another difficulty lies in the ^fuct--that such filters do not cut off sharply, but generally Im>i<1" i.f light, may assist in the biochemical allow definite increments of longer or shorter of rickets therapy. This opinion, based wave lengths to be present in a selected band, --..ii .vUininary qualitative studies, was strengtb- which increments must always be of unkuown liv the findings of Sonne aud Rekling,4 who relative importance, if iu fact there be a differ xicsrstcd *2330 to 3023 as an antirachitic region. Shire 1930 but few reports bearing upon this iihjrrt have appeared. limul-son*'* reported hiv and prevention of rickets in rats by radia- from either a quartz mercury vapor arc r inm a GE S-l bulb and defined the gram siU.rh-s of these heterogeneous radiations neees.*ry In cure a rat whose skin had been depilated. N*>attrtupt was made to evaluate different parts tin* <c|iectrutn. Gortcr2 reported that only t 3100 Angstroms are active. Kuudson .ud l--nfi>rdr reported in abstract form that antirachitic effectiveness of monochromatic titr.i"ii.|,*t light does not correspond to that pro*:i -*.ni rrytheuia, but details are lacking. ifiiuni ttudy, continuing with optical filters *' *t"rial glasses, quartz anti solutions of nickel **'hV- ami copper sulfate, enabled us to invevti-i'- qMvtral zones of decreasing width. One ence in the relative effectiveness of various wave lengths. *'. .. By thO H ter method it was determined that a Jnnd made up principally of light from two iues of the mercury arc spectrum, namely, 3023 and 3130 angstroms, showed some therapeutic value in experimental rickets in rats. Subse quently; by tire use of u water-cell monochrom ator. described by Harrison,* we were able to eliminate from further consideration the line 3130, which was completely ineffective at an apl plied energy of approximately 1.75 gram calories per rat. ' - . All the subsequent work .was done with a Rausch & Lomb quartz monochromator type Xo. 33-8fi-03) with prisms S cm. by 8 cm., wiiich transmits sufficient energy from a 6 inch. 220 volt Uviarc to permit treatment of rachitic vats with single lines of light. . ** * <** lle e e a n h LAbartitort*, M n iM th u e ttla Erprrhnrnlal 't .* T 'lU f o ltu ty , * ,W ., 7S P rom *h* D e p ir t m r A t o f fltolotfV jim t The nrrangement of the equipment used in / . >(* **. '* 'm . In atitu tA o ^ T < ttto a I v io `i Cam . the phase of the investigation dealing with ' - f . k A n W . U '^ o i r K l o r o f n to ta g tro t K r o ttr r h U'ttu monochromatic radiations is shown in figure 1. '* * Vr-*t+m+*\t it I'hy n il Jiiv h -m ttry. )! o f 'rK hA O lhk')'. IC atrU , H db*rt i -- K d r a r i h Iu a white trausitc horsing, R. open at top w h .ry , **<* H it o f uhtuil*h*ottr** * "T h ll of T itnloiuut.e'),''.` and bottom and raised from the bench on log, a vortical C inch Uviarc, A, was n!n.-<vi :.. '