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FILE NAME: DD< DATE: DOC#: D< OCUMENT DESCRIPTION:ZZKWZZZdW WZ/D rI'/zr> Prnci])/cs and Practice oj' INDUSl"RIAL !\1EDICINE Edited uy FHED J. WAMPLEH, ~l.D. Professor, Prcventn'c and industrial Mcdtcwc MEDICAL cOLLh("o}<.. of VIRGINIA CONTRIBUTORS OtIS L. Anderson Robert A. hehoe R. ~. Anderson ]\,L H. Kronenberg Anna M. Baetjer B. E. Kuechle J. J. Bloomfield Matthew Luckiesh J. A. Calhoun Willard Maehle J. M, Carlisle R. W. McKee George H. Cross Sarah I. Morris Donald E. Cumming Kenneth 1\10rse Charles F. Engel Frank K. Moss John H. Foulger C. M. Peterson Augustus Gibson D. F. Robertson T. Lyle Hazlett F. S. Rossiter Albert Hemming William A. Sawyer .1". Y. Heyroth Louis Schwartz J oaHlll', J OllllSOll Lurin A. TllllmjJ"ull R. T, Johnstone Fred J. Wampler George ZUl Williams A William IVood Book BAL'l'lMOll.E THE WILLIAMS & WILKINS COMPANY LIST OF COKTRIBUTORS ANDERSON, OTIS L., B.Sr'", M.D., F.A.o.P. Surgeon, 1Tnitf'r1 St3.tf''' Pl'hlw Hf'[llth ~f'ryj('f') AS"lst:mt Chif'f, Pn'jsion of Venereal Diseases, ~atiullal Institute of Health, Bethesda, Mar:vIand. ANDERSO:\" RICHAHD N., B.A., J\LA. Director of the Division of Rehabilitation, Special and Adult Educatjon of the Virginia, State Department of Education, Richmond, Virginia. BAETJEH, ANNA 11'1., Se.D. Associate in Physiological Hygiene, School of Hygiene and l)ublic Health, The Johns Hopkins University, Baltimore, Maryland. BLOOMFIELD, J. J. Sanitary Engineer, United States Public Health Service, and Chief, States' Relations Section, Division of Industrial Hygiene, National Instil,Ule of Health. Tkthesda, IvfaryhwJ. CALHOUK, J. A., ::\f.D. Tvfedical Director, American Viscose Corporation, 'Wilmington, Delaware. CARLISLE, J. M., :\f.D. 1\1edical Director, Merck and Company, Rahway, New Jersey; Professor of Industrial Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania; Executive Director, Bureau of Industrial Health and Hygiene, New Jersey State Department of Health. CROSS, GEORGE H., M.D. Associate Professor of Ophthalmology, University of Pennsylvania, Gradu:l (,. 8ehool of ]\Tedieine, Chester, Penlls:yh-ania. CUMMING, DO?\,ALD E., 13.8.* Associate 1'rofc",,,or, Dcp<"rtmcIlt of l\Tedicilw, and Director, Division of Industrial Hygiene, University of Colorado School of 1\1:edicine, Denver, Colorado. ENGEL, CHAllLE" F., T\1.D. Assistant Medical Director, 'Westinghouse Electric and ::\fanufacturiug Company, East l"'lttsburgh, Pennsylvania. FOULGER, JOHN H., M.D., PH.D., F.A.C.P. Medical DirC'ctor, Ha~kell L::thoratory of Industrial Toxicology, \Vilmingtoll, Delaware; Associate Professor of Industrial l\I:edicine, Medical College of Virginia, Richmond, Virginia. '" Deceased lJ,,-oLlllbcI, 1\112. IX x LIST OF COKTHlBUTOnS GJIl~ON, Am;1 1S'I'H", M.D. PhYf'ieja,n, Merek alld COlllpany, Rahway, New Jen'ey. HAZLETT, T. LYLE, M.D. Medical Director, We!'tingh011!'f> };~lprtri(' and Manufacturing Com)l~my: Protr""nr, ] nrlll"tri:1J l-I ygirn 0 , Pni"crsity of Pitt2hurgh, PiH:c bUl gh, P ellllbY Iv<Lnia. HJCMMINn. ALR"ERT, M.13., Ch.B. PhYbieiall, l'vIerek <LllO Company, Rahway, New JerRey. HEYROTH, FRANCIS F., M.D. Assistant Professor of Research Phy~i()J()gy, Ketterillg Laboratory of Applied PhYl'iology, Coll<,ge of J'vIedicine, University of Cincinnati, Cilleinnati, Ohio. JOHKSON, ,}OANKA, R. N. Supcryisor, Industrial ~ursing Division, Employers l\Iutual Liability Insurance Company, l\1ilwaukee, vYi::;consill. JOHl'\STOKE, HUTHERFORD T., A.B., M.D. Director of the Department of Occupational Disease!', Colden Rtate IIo'piLll. Ln,,", Allge]r.", Califomia; F\)rJlwrly Assi,i alli Professor of :\IGJicillc, "GllivCl::,ity uf Pitt::;lmrgh School of Meuicine, Pitts burgh, Pemlsylvania. KEHOE, ROBERT A., M.D. ReSe<llch Professor of Physiology, DilCc10r, Kettering Laboratory of Applied Ph;ysiolog:r, College of Medicinc, TJniversity of Cincinnati, Cincinnati, Ohio. KnoKE::\BERG, J\1wroK II., l\1.D. Chief, Division of Industrial Hygiene, and Industrial Medical Supervif'or, Dt'partmt'nt of Public Health, State of Illinois; Assistant Profcssor of Bacteriolop::-' and Public Health, Universii,~' of IllillOi~ Chicago, Illinois. KUlXHLI:, B. E., A.B. Vice-Prc"ident and Claims Managcr, Employers Mutual Liability Irlf'llraJH:e Company, ,Vausau, 'Vi!'(,oIl~in. / LUCKIESH, MNl'THEW, D.Rc., D.E. Director, Lip:hiing Research Laboratory, General Blndl i(' Company, Nela Park, Cleveland, Ohio. ::\iACIILE, WILLAHD, 1\1.D . .\88ocia.tk Pr,)kbC,O! 01 H.esearch l)hysiolvgy, Associate j)irer:ior, J(et tering Laboratory of Applied Physiology, College of Medicine, 1Jniwrsity of Cincinnati, Cincinnati, Ohio. l\1cKEE,lL W., PH.D. Instruct or iE IllJu",lrial 1I.\ hiellC, ScLuul uf Public IIc",ltL, HUI v111 d t InJvcr,~ij~T, llostOl1, ~1~'", :1C'hll,'ctt.Q LJi-i'J' OJ<' CON'J'HI HUTOHS Xl }\fORRIS, SARAH I., 1\1.D., F.A.C.P. Professor of Prcventin J\lcdicinc, "'omans Medical College of Pcnnsylvania, Philadclphia, Pennsylvania. IvloRsE, KEKNETH, M.S. lndustri<L1 Ellginem, Dlvibiull uf Indu::,ui",l Hygielle, Illilwib SLate Dcpartmcnt of Public Health, Chicago, Illinois. 1\10S8, FnM'J-;. E., E.E. Physicist, Lighting Research LuJwratory, General Electric Company, V" Nela Park, Cleveland, Ohio. PETERSON, C. 1\1., M.D. Secretary, Council on Industrial Health, American Medical Association, Chicago, Illinois. ROBERTSON, D. F., M.D. Associate Medical Director, Merck and Company, Rahway, New Jersey. ROSSITER, FRANK S., M.D. Medical Direct or, Carnegie-Illinois Steel Company, Pittsburgh, Pennsylvania. SAWYER, WILLIAM A., M.D. Medical Director, Eastman Kodak Company, Rochester, New York. SCHWARTZ, Lours, l\1.D. Medical Director, United States Public Health Service, and Chief, Dermatoses Investigations Section, Division of Industrial Hygiene, National Institute of Health, Bethesda, Maryland. THOMPSON, LORIN A., PH.D. Director, PopUlation Study, Virginia State Planning Board, Rich mond, Virginia. WAMPLER, FRlDD .J, M.A., M.D., Iv1.P.H. Professor, Preventive and Industrial Medicine, and Administrator, OutPatiellt Clillie, Medical College of Virginia; Health Consultant, Southern Biscuit CompallY, Richmond, Virginia. \VILLI AM!', GEORGy.', ~TTR, 1\1 n Associate Professor of Pathology, Medical College of Virginia., Rich mond, Virginia; Member of Armed F'orces, Lt. Com. U.S.N.M.C.R. 372 PRINCIPLES AND PRAC'l'ICE OF INDUSTRIAL MEDICINE VII. OTHER PNEUMOCONIOSES There is considerable disagreement in the medical literature concerning the exact etiology of certain types of pulmonary fibrosis due to dust inhalation other than silica dust. Asbestosis, siderosis, and anthracosis are the most imports,nt' of these fibroses. Asbestosis It has been well proven that a peculiar type of linear pulmonary fibrosis is 'caused by minute asbestos fibers inhaled by workers in industries utilizing asbestos for the manufacture of fire resisting material, insulation, certain fabrics and ropes, paints, roofing, tile, etc., as well as the manufacture of asbestos itself. ' Asbestos is magnesium silicate and is the only silicate which has experi- mentally been proven to produce a pulmonary fibrosis without exposure to silica. The onset and clinical course of asbestosis is similar to that of slowly progressing silicosis ~nd the symptoms in the later stages are identical. , Fatal termination is usually by complicating pneumonitis, cardio-vascular decompensation, or tuberculosis. The roentgenopathology is typical and not difficult to differentiate from silicosis. Gloyne and Merewether state that the roentgenological appearances of asbestosis are revealed typically as a general lack of translucency with a fine pinhead mottling. This is the characteristic "ground glass" appearance. The film should always be compared with a film of a normal patient and a film of a silicotic patient taken with the same exposure. The diagnosis depends upon a definite history of exposure to asbestos dust including sufficient period of exposure, roentgenological appearance, decreased pulmonary capacity, and the finding of asbestos bodies in the sputum of patients not yet removed from exposure to the dust. These asbestos bodies are well described and usually illustrated in most text books of clinical pathology. The pathology may be summarized in the single statement that it consists of a persistent, progressive, diffuse perialveolar fibrosis of the lungs. The fibers may be seen on histological examination to lie embedded in the fibrous walls of alveoli and bronchioli and each fiber appears to be encrusted by an iron-containing yellow pigment. As would be expected, in the later stages the fibrosis becomes confluent and massive. Siderosis Siderosis is chiefly a red pigmentation of the lung tis5ue due to inhalation of iron-containing dust frequently found in hematite miners. E}'.'perimentally, fibrosis has not becn produced by pure iron or iron oxide dust PNEUMOCONIOSIS ,./ 373' :#1 ./;- and only when mixed with hazardous concentratiollS of silica dust d~~"~.:' ::~ fibrosis result. Therefore, unless the patient is also affected with silicoSis"'1,; siderosis by itself is asymptomatic and p~oduces no roentgenological ;or;~ clinical findings. '" ; ,'. Anthracosis Black pigmentatiori of the lungs due to inhalation of smoke and other ~ypes ~f ca.r?on particles is common particularly in .residents of 'large" mdustrral CItIes. Most marked blackening is' produced in coal miners..' no There is some controversy concerning the question as to whether o~ not' carbon dust of itself can produce a pUlmonary fibrosis. There is con:..:. elusive experimental evidence that pure carbon dust will produce fibrosis. It is the author's opinion that all instances of fibrosis in anthracotic lungs' are due to an admixture of silica dust in the inhaled air or an infla~atorY ' fibrosis due to respiratory disease. Anthracosis is asymptomatic and~" . produces no clinical findings or disability. REFERENCES American Public Health Association: Report (joint) of the Committee on Pne~o-' 7}; c~niosis ~nd the Co=ittee on Standard Practices in Compensation of Occ~p~~ :". / tIonal Dlseaees, Year Book, 1933, p. 1 0 0 . ' . , " . " ,. ", "",' BELT, T. H., IRWIN, D., AND KING, E. J.: Silicon and dust deposit.<:; in the ti8SU~S of ;.: :;~~ persons wi thout occupational exposure to siliceous dust.<:;. Canadian Med. Asso~.' , ' J., 34 (2): 125-133, 1936. . , . > ' ,,~, BURKE, H. E.: The detection of mineral particles in the sputum in silicosis. J. fud. Hyg., 17: 27, 1935. . .;.. " .,', COLE, L. G., AND COLE, W. G.: Dyspnea of silicosis: What causes it? J. A. M. A., . ",:~ 113: 1216, 1939. . . .,' ,,' ! CUMMINS, S. L.: The augmentation of action of anthracite and other dusts by de~d tubercle bacilli. Brit. J. Exp. Path., 21: 64-70, Feb. 1940. ' DRINKER, P., AND HATCH, T.: Industrial Dust. McGraw-HilI,1936. ' ')" ELLMAN, P.: Pulmonary asbestosis: its clinical, radiological and pathological fea-. "!,' tures, and associated risk of tuberculous infection. J. Ind. Hyg., 15: 165, 1933,' _ ,',. GARDNER, L. U.: Pathology of so-called acute silicosis. Am. J. Pub. Health, 23: 1240, 1933. ,\..,{.:,.." .. ",;.;, GARDNER, L. U.: The pathology and roentgenographic m~festations of pneumo-' . ..' coniosis. J. A. M. A., 114: 535-545, Feb. 17, 1940. ". GARDNER, L. U.: Recent developments in relation to silicosis. Ind. Med., 9: 45-49, Feb. 1940. ' - . " . ''', GARDNER, L. U.: Studies on experimental pneumonokoniosis. V. The reactivatio~" ,::i, of healing primary tubercles in the lung by the inhalation of quartz, granite 'and .",' ~.'.!!: carborundum dusts. Am. Rev. of Tuberc., 20 (6), 833,""(Dec. 1929). ' " "';-::: ''!':,r GLOYNE, S. R, AND MEREWETHER, E. R. A.: Asbestosis. O. & H., (Brochure), 1938:'''~''-' ,,~"' HATCH, T., AND THOMPSON, E. W.: A rapid method of dust sampling and approximate;:,. ' quantitation for routine plant operation. Ibid., 16: 92, 1934. , ':"''''''.~" INTERNATIONAL LAlloUR OFFICE: Pneumoconiosis, a list or'refcrences siudie~ ~i:J.(f">"' "N reports, series F (Ind. Hyg.), No. 15, 1932. " ,- <