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Talc Pneumoconiosis by S.H. EL-GHAWABI, G.H. EL-SAMRA and H. MEHASSEB Ministry of Labour, Cairo, and the Department of Industrial Medicine and Occupational Diseases, Faculty of Medicine, Cairo University. Pure talc a ( hydrated magnesium silicate ) is similar in cahlseomiincala cfoibmropuossitifoonrmto washbiecshto, s.mItayis abeflakmyomreinefriablrobguetnoiccc6u.urs. Iamndpufrreencfohrmchsaolkf twalhcichhavies bueesend knboywntaailsorssteattoite,msaorakp csltootnhe. uWsehdenfocrruashveadr,iettaylcoofccpuurrspoassesa. smooth bland powder which is magneTshiuemchriiecfh dceaplcoasrietsouosf rtoaclcksanadndsoaalptersetdonbeaosicccurrocinksaltseurecdh ians asessrpoecniatitnioens awnidthmfirceae sscilhicisat.s8,13; it is therefore rarely found In Egypt the good quality talc is present in Hamataarea, AprbouduGcthioosnsoanmoanudnteDdehtorib29i0n0tthoensE. astern Desert. In 1965-66 its The first account of talc pneumoconiosis was given by Thorel in 1896. The numerous investigations that have been ocwarnriecdanouctautsheerpenaeftuemr ohcaovneiolseisf.t liWttlehildeousobmt ethafotrmtalscofdutasltcohnavites vbeeenntilathtioounghant dtodifbfeusiionnnohcauvoeusb1e9e.n Irmeppoaritremdeinnt woofrkeprsulemxopnoaseryd ftoormtalsc9,,1t0h,1e1,1fi2b.rous forms being more harmful than granular rinepoErgtDyedpe.tspnitoe ctahseeslaorfgetaalmc oupnnteuomf toaclconmioisniesd,hmavileledsoandfahranbdeleedn 330 .carrieTdhoeutprienseantplraenptorftorgimveisllitnhge orfestualltcs wofithathsetuodbyjetchtaivt ewaosf winovreksetirgs.ating the prevalence of talc pneumoconiosis among the Material and Methods lies inThteheplianndtussturrivael yaerdeaisosfpeGcihaalimzerda f.oAr tmithlleingtimofe taolcf atnhde Tsthuedymiitll eims palonyeodld,50powoorlrykevresntaillaltoedf wbhuoimldiwngerwe iethxpaospeedrmtoatnaelnc.t cloud of dust which permits the air in the work place. The serqahnuwogeivnnetmellyelaertidpenrugilavilcneortinisoztercodrlussabohcyfes.dadnusiPnteetloraesrcoestnrmiacclaolmlempprrlioelpltt.eelaclyctTievshleaecwkhepiniqocguwh.idpemarreenistsutbhasneedn in theChlaebmoircaatloraynaolfystihseopflathnet. raw materials was carried out of duTsthineesMsidingesthi eimwpoirnkgeernvwirao3nmuseendt fuosrinegvadliusatitlilnegd thweatedregarneed atthhlceeonhaoiarln-baalosyrsnethededfsuoasrmt dupuslisinntggcomaunendtosirudmainn.darypTahmretiiccclreoolslsecicoztpeeedd(siamstmraigpbnlueitsfiiocnawtieoornef jw1e0vo0erklxo)pflaatnchede. awSorpkeenrcserancdells-evSearmalplseasmwpelerse twakeeren attaktheen braetatehainchg occupEatxioamnailn,atpioasnt oafndtheprwesoernktersmeindcicluadl edhisitnoqriueisry asabowuetll ihaes fCalminiilcyalbeisxtaomryinaintionadwdiatsiotnhento cathrreiedagoeut aanndd sthmeokcihnegst ohfaebaitcsh. uwpoornkerbyw3asdXiff-rearyenedt sponeciaalilsatrsg.eSpfiulmtu.m Fexilammsinwateiroen fcoormtumbeenrctelde evbaeacnchitlilliactaowsraeys cafaturnrlcieetaidostno3uwt aissnucsheovmaeleuxacatamesdeinsatbuiysoinndsgirewcatereGsmodmeaaarrtdea.9n-dlTitehirne spprierdoimcteetde,r. theThfeorcveitdalecxappiraactiotyrywvaosluemxpersesfsoerd 1inanpderc3entseocfonthdes 331 wtheereinedxiprerecstsedmainximpeurmcenbt reoafththinegtoctaapl afcoitrycewd asvita-a1lsocapeaxcpilryesasnedd1 as percent of the predicted. Results and Discussion obtainReedsuflrtosmofdcifhfeermenictalmainnpaslysairse osfhotwhen diinfferTeanbtletyp1esaonfdtalict schaonwbsethseeenrestuhlatst ofrfeethesileincaviroinsmceonmtalpleintevleystigaabtsioennst.. Table 2 Table I -- The quantitative chemical enalyaia of talc fri m different m ines. Mine Silicate FesOa AI2 O3 CaO sMgO Acid C O1 2 3 3V '0 Derbib mines 57.35 1.6 3.02 1.71 28.6 -- 0.05 E l-A ngohria mine 61 0.35 1.15 0.18 32.95 0.18 0.05 Omm-Solimat mine 60.1 0.48 3.02 0.28 33.13 0.32 0.0J Abu Gerdi mine 60 0.83 2.17 0.28 32.59 0.1 0.02 K riem -m ine 59.7 0.64 1.04 0.71 32.2 0.1 0.18 Abu Marw mine 59.4 4.55 1.54 0.14 30.77 0.14 0.04 Omm Kriera mine 55.83 5.95 3.05 0.17 30.49 0.27 0.06 Al-Nekhala mine 57.9 5.1 1.9 0.13 30.41 0.09 0.07 Area Table 2 -- Reaulte of air analysis. No. oi Dus! counts MPPCF Mean particle site distribution samples Maxim. Minim. Mean --2.5p 5 p - lO p- 2 0 p _ 40 p + In Iront ol mill 12 83 54 68.5 49% 50% I % -- ~ Behind mill 12 35 25 30 40% 55% 5 % -- -- Package area 12 111 73 92 69% 30% 1 % -- -- -- 332 -- Table 3 -- W orkers distributed according to age, duration of exposure and X-ray diagnosis. Age X -ray D u r a t i o n o f e Xp OSUI e years findings * 5 years 5 - 15-- 2 5 + Total P ,M ,N ,A ,B ,C 20-- L Total 4 2 6 P ,M ,N ,A ,B ,C 1 30-- L 1 Total 7 10 1 1 1 18 P.M ,N ,A ,B ,C 40-- L Total 1 3 5 2i 3 3i5 6 3 17 P ,M ,N .A ,B .C 336 50+ L Total 213 3 9 P.M,N,A,B,C -- - 6 total L 113 Total 16 18 10 4 10 16 6 50 * Classified according to 1L0 classification of radiographs of pneum oconiosis 7. 333 Results of medical examination : Fifty male workers were examined, none of whom had a Tpaasbtleoc3cusphaotwiosnatlhehidstiosrtryibuotfionexpoofsuwreorkteorsanayccokridnidng ofto daugset., dcluarsastiifoicnatioonf oefxrpaodsiuorgeratpohstaolfcthaendpnetuhmeocXo-nriaoysisfirnedcionmgsm. enTdhede 5b2y%theofILthOe iwno1rk95e8rs wwaesreusaebdovtoe dtheescraigbee otfhe40Xy-reaayrs fainnddi3ng2s%7. wsheardeowexspowseerde foobrse1r5veydeairn3 1o0rwmorokreer.s Naloldouflawr haonmd wcoenregleoxmpeorsaetde fmoor repetrhioands 4o0f ymeaorise othlda.n 1L5inyeeaarrsanadndretaicllulaerxceopptaciotniees wweerree opbersieordvsedofinex6powsuorreketros tablcetowfeelness ththeanag5estoofm3o0re*4t9hayne2a5rs yeaaftres.r TorhrZeeancdase2s hhaudd XX--rraayy fsinhdadinogwssswughgicehstiwveereofcltausbsiefriecdulaossissu. spect None of the workers below 30 years of age had X-ray abnormality. Cases of Talc Pneumoconiosis The diagnosis of talc pneumoconiosis in the present study waraes abahsiesdtoruyponofthaedcerqiuteartiea seuxgpgoessuterde b(ypKrolleoinngfeeldd eetxaplo.nsuwrehictho accphopensectaernratonreacnteitogneinsnotggarrlceaamtpenrceotuhnmasniosct2e.o0nntmiow'slliiistohnwtaphsaerdtidecislacegrsin/bfoeis3dis.oafsTachiroe)nsaXisn-tdirnagya obfothfinelunlagcyfiemldosttwlinhigc4h amnday nocdoaulleasrceshaanddowisn dthisetrilbautetred stoagveesr Emnalyargeshmoewnt otufmhoiularr gliikaneds m8 asasneds, incmreoassetdl ylineilal-rdemfianrekdin5g,6s,185. were reported. In addition, plaques of opaque material were dsbieinzsgaclrreriebeliddne3epa6o1rs,ditiesnpotohsvietesrpienlrairptghheeerrpyeagriotosfnothfoef ttlhhueengdsliuanwpghhriacfhgiemlvdatsor.iemdaTsfhrseoivsmee were called talc plaques. In the present study exposure to dust concentrations 334 -- Figure 1. exceeding the threshold limit values for talc has been proved by the environmental studies17. workeTrsheexparmevinaleedncweasof32c^a.sesAmofongpntehuemseocoenxipoossiesd amfoorngmtohree tfhoaunnd15a pyreevaarslentcheeofp1re4v.5a%le,ncoef cwasaess w87i.t5h%e*vidSeinecgealofeftibarol.si1s6 i1n0 taylecarms intheerys aonbdsermveildleras p; raemvaolenngcethoofse25e.9x%po.sKedleifnofremldoeret athla.1n0 arevpeorargteed paeripordevoalfenecxeposoufre37o%f 1i0n yetaalrcs. mTiolllekr,s howwheoverh,afdounadn aexpproesveadlenfocre 10ofye6a7r%s orofmotarelc18.pneumoniosis among workers revealRedesuthltast othf eexyaomuinngaetisotnooff tthhee 1g6rocuapseswoafs pn3e0umyoecaorsnioosilsd -- 335 Figure 2. wcahseilse wthiteh onldoedsutlawr aasnd59coynegalrosm. erTathee oapvaecritaigees awgaes 5in0 4theyea1r60 w41h.i8leyeinartsh.e Tgrhoeupavewriatghe ldinueraartioanndof reextipcousluarre sohfadaolwl scasietswoasf pconneugmloomceornaitoesiospwacaistie2s1.6it ryaenagresd. frIonmth1o7seto w3i5thyenaorsduwlaitrh anadn 4wav-i3teh5raglyieneaeorasfr. 2a4nA.d2i:lrivetihtsiecautoalasvreeroatgpaeacl.it1dieuresrpatowiroatnsed1oo7nf.5ceyaxesepasrosswuahrneod dtiehnveerlcoaanpsgeedes efrvoimden1c6e-2o4f mtalocntphnse,umproocboanbiloysisbeacfatuesrepeorfiodexspoofseuxrepotsouruenruasnugailnlgy hmigilhlerdsuswthocondceevnetlroapteiodnsp.neuKmleoicnofenlidosiest aaftle.r9erxeppoosrtuerde foonr pJe6ritoadlcs wvaeriygihntged farovmerag1e3-e2x6poyseuarers w(aasve6r8ag9e m2i0ll.i4on ypeaarrtsic)l;esthpeer mcuebainc foot of air. Clinical picture : Thirteen (81 %) of the 16 cases of talc pneumoconiosis had no symptoms. Productive cough was 336 Figure 3. K* 5* present in 3 cases and dyspnoea on moderate exertion was present Oinne2 ccaassee,shoinwevwehro, mhidconn)suommerpiltaeintodpeicsiptiitee9 thweerepreosbesnecrevedof. nppanotedhuuomlgaonrcooamnnodionsicciosnawgnilt!ohmwseleirgraethetaboorspenancotitdiineissa.7b5i%liCtyloifnhiaccvaaeslebsse.igennCsraeswpesoerroteefdt2na,ol8ct. sByumt pKtolmeinfineld14etoaf lt.h9efioru1n6d cdaysseps.noeIit wtooulbde bea reparseodnoambilneantot awHsiostuwhmetveheetrh,eaKxttleetnhintefeoplfdreteshetenacle.1p6aafnthodoulndodeggidcryeaselpnooofredarytaosdpihnoeoloetgahiecawplroeudfliodnmdiivnnagarnsy.t esyvmidpentocme oinf p2n9etuamlcocmonililoesriss. 15Coofughwhwoams thhaednenxot inrafdrieoqluogeniccayl fTihnegyersalsion 1o2bsaenrdve8d obfatshael 4c3rewpiotarktieorns,s reasnpdecctilvueblbyi.ng of the -- 337 -- X-ray Findings : In the present series the observed X-ray' fluinndginfgiesldws.ere(:2)(LV)erLyinsemarallanpdunrcettaicteulaorpaocpiaticeistie(ssizafefecutpingtobo1t.5h*1 minmd)iffdeirsetrnitbuctaesdeso. ve(r3b)>thMhlurnognofdieulldasr a(nsidzeva1ry.5in-3g minmd)enasnitdy nacononddfululwaeernret(soidzpiefafcufirtsoieemlsy 3m1aof0sftelycmtwimnig)thoitplhla-edciet2fiienseludwnegbroerfdoieeblrsdsesra.vnedd(4oifn) v4aLrcyaarisngeges asilzsoesthaeffelcotwinegr zmoonree iacomonmeonclayset.heInuppaenrotahneirl mcaidsedlethzeonelsarbguet otohpueatlcirniitegiehstwach9oasdotbovpseehrrcyveendwioeilnlandogeolfeeinacenaddseirbr(oeFrgdiugel.rasr.1it)y.(o5Sf)imthisOladbrilairtpaehdrarioatigloomngaictoaiclf atcohbofanntaoctrrteemultemiaoclontiatsuiserio-sslfikwwteaeiltrcheshorasbeedpscotoowrrunstcdetdawirnlyeg,r2e,f4tih.nb8eor,ot1b8t-idrcouAnerelciahvtociiostailfoetiobns3rsoa.esntiOdsathcalae.l1ourssnsiuebngegglbieauesrvteteeatddso that secondary tuberculosis was responsible for such shadows. slightVerenstitrlaicttoirvye Fuvnencttiiolantsor:y Inimopneaircmaseentthecroenswisatsenetvidweinthce thoef amount of librosis observed radiologically. Ventilatory functions eaimntnidaltlheld.re9isf,f1rwu0e,iss1tith1nogaffonudctanhwpdeaictgheirtovyouiudtpefronarcwdeiceoarleorobfgowinciiatmhlmipenoavniinrdoeoxedrnimdceeavleoinnfltiimplanaitetosgu.rrmyoouKcp(oluennoiincfotftsieaoillsndc. wluenrge OdmitaahgreknrionsCgesad.seassThwheaistvehincgRoausdludisoplbeoecgtiecaaorlplyaAccbitaniseoesrsm(oZafl)ittayl:corTphnirneeucermecaoascseeods nfoilolosiws; upthiosfdtihaegsneoscias,seshofworevaer,sufisficdieifnfticupletritood moafketimweit,houint svinuiecgwrgeeasostefivoethfeolfuwngitduebmevraacrrukieliontysgiss.ofoTnwceoondocfitaiosetnhssembthaadthaXvmi-narygay ceasxuhtesaendsoiwvanes tvpoeunltmtuibloaentroacrruyyloafsuninsdctiiponlne.tuarlacTlhwefiobqrrkuoeesrissstioanhnadosf bmieneacnrrkeeadbs:eoduimghsputasicraembpoetuinbttilibtoyyf -- tSuibegeercluelot usal.1i8n.feCctaisoens ohfatvaelc bpeneenumorecponoirotseids8,1a4s.socWiatehde t hweitrh ttuhbaterciut lopursesiennftesctioinn iwnortkaelcrs inedxupsotrsyedpretosenstislictahedussatmeis rnisokt yet clear. Other Chest Conditions : Five cases had cough, dry or yperoardsucatnivde,hafdornpoerXio-drasyoafbtnimoremavliatryy,ing from 3 months to 2 Summary spilzaenst Twwhaeesrefeonsuvunirrdvoenytomedeb.net mTanhudechwleoivnrekleixnocgfesptsaolpocufldathtuieostnMoofAfCthaetianrlcesamplilirlalbitnhlege owuotrkofartehaes.50Swixotrekeenrscaesmesploofyteadlc inpnetuhme ocpolanniotsiasnwderewdhoiagnhoavsde cbmoeouerngehe,thxdapynosspe2nd5oefyaoeraorpns.eerixoSedrostmiooenf wctahimsielees oovtfahreytraisnlcgwefprrenoemfuremeleooscsfosntyhiomasnipsto5mhatsdo. TnohdeulaXr-arasyweflilndaisngcsonifnlucelundt eodpacliintieeasr. aTnhde vreetnictiulalatorryofpuanccittiieosn,, wmaosdewraittheinfibnroosrmis.al limits in all cases except one who had AElc-kEnnoawnyledfgoermdeonintg: thTe heenvairuotnhmoresntawl isshtuditeos. thank Mr. F.F. References 1 -- Alivisatos, C.P., Pon ikakis, A.E. and Terzis, E. : Brit. J Industr. Med., 12. 43, 1955. 2 -- Cavigneau*, A., Chtries, A., Fuchs, S. and Tara, S. : Archiv. Matad. Professionnelles, 34, 1950. 3 -- Greenburg, L. : Yale J . Biol. Med.. 19, 481, 1947. 4 -- HLoanled,onL,.WI9.6:0.Symposium on Industrial Pulmonary Diseases. Churchill, 5 -- Holt, P .P . : Pneumoconiosis. Arnold, London, 1957. 339 -- i 6 -- Hunter, D. : The Diseases of Occupations, 3rd Ed., English Uni versities Press, London, 1963. 7 -- International Labour Office : Occupational Safety and Health, 9. 63, 1959. 8 -- Kipling, M.D. aod Bech A.O. : Trans. Assoc, lndustr. Med. Officers, io, 85, 1660. 9 -- Kleinfeld. M ., Messite, J., Shapiro, J., Swencicki, R. and Sarfety, J J. Occ. Med., 7. 12, 1965. 10 -- Kleinfeld, M ., Mersite, J., Shapiro. .1. and Swencicki, R. : Archiv. Environ. Hlth., 10, 431, 1965. 11 -- -- , -- , -- , Kooyman, O. and Swencicki, R. : ibid, 9. 559, 1964. 12 -- Lanza, A .J. : The Pneumoconioses. Grune and Stratton, New York, 196a. 13 -- Nam,:y, A. : Economic Geology, El Araby Booshop, U .A .R., 1958. 14 -- Parmuggiani, L. : Ress. Med. lndustr., 7, 16, 1948. 15 -- Scansetti, C ., Basetti. L. and Geheni. F. . Med. Lovoro, 54, 764, 1963. 16 -- Siegal, W., Smith, A.R. and Greenburg, L. : Ant. J . Roentgenol., 49, II, 1943. 17 -- Threshold Limit Values for i960 : Archiv. Environment Hlth., 140, 1960. 18 -- Tolk, J.J.C . : CIS Abstract, 1812-1964, 1967. 19 -- W19e6i7ss.. B. and Rocttner, E.A. : Archiv. Env/ronm. Hlth.. 4, 304, -- 340