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A Benign Pneumoconiosis

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A Benign Pneumoconiosis Thorax: first published as 10.1136/thx.31.1.30 on 1 February 1976. Downloaded from Thorax (1976), 31, 30. Baritosis: a benign pneumoconiosis A. T. DOIG Formerly HM Deputy Senior Medical Inspector of Factories Doig, A. T. (1976). Thorax, 31, 30-39. Baritosis: a benign pneumoconiosis. Baritosis is one of the benign pneumoconioses in which inhaled particulate matter lies in the lungs for years without producing symptoms, abnormal physical signs, incapacity for work, interference with lung function, or liability to develop pulmonary or bronchial infections or other thoracic disease. Owing to the high radio-opacity of barium, the discrete shadows in the chest radiograph are extremely dense. Even in the most well- marked cases with extreme profusion of the opacities, massive shadows do not occur. When exposure to barium dust ceases the opacities begin slowly to disappear. Nine cases of baritosis occurring in a small factory in which barytes was crushed, graded, and milled are described. Two of the cases occurred after only 18 and 21 months' exposure, and 9 of the 10 men employed for more than one and a half years had baritosis. Five of the affected men examined at intervals since their exposure to barytes ceased in 1964 showed marked clearing of their radiological abnormalities. Until the middle 1930s no non-fibrotic forms of probably suffering from mixed dust pneumo-copyright. pneumoconiosis were known, and the term coniosis from silica and barium. Subsequent 'nodular fibrosis' was commonly used to describe writers, however, stressed the benign nature of the radiographic appearances in those cases which baritosis, contrasting the lack of subjective symp- are now termed simple pneumoconiosis, on the toms and abnormal physical signs with the assumption that all dust nodules were fibrotic. intensity of the radiological changes (Arrigoni, http://thorax.bmj.com/ Doig and McLaughlin (1936), describing the 1933; Feci, 1933; Preti and Talini, 1938; Spedini siderosis of welders, were the first to postulate and Valdini, 1939; Rosmanith and Knopfelmacher, that some dusts might lie inertly in the pul- 1957; Gombos, 1957). As with stannosis, the in- monary tissues without producing fibrosis or other tensity of the individual opacities on the radio- permanent reaction, even although they were dis- graph is outstanding and is due to the high atomic cernible on radiographs by their radio-opacity. weight of barium (137). With the exception of a Numerous reports have established the existence brief description given at the International Con- of such a benign pneumoconiosis, and Doig and gress on Occupational Health in Vienna (Doig, on September 24, 2021 by guest. Protected McLaughlin later (1948) showed that the radio- 1966), no cases have been described in Britain. logical opacities in welder's siderosis might com- The present communication gives more detail and pletely disappear by natural removal of the also the results of follow-up examinations of some particles once exposure to the iron fume ceased of the cases then described. or was considerably reduced. Stannosis due to the inhalation of tin fume or dust is another example of a benign pneumoconiosis (Robertson and BARIUM: TOXICOLOGY AND USES Whitaker, 1955). A feature of stannosis compared The two chief ores of barium are barytes (barite), with siderosis and fibrotic forms of pneumo- BaSO4, and witherite, BaCO, the former being coniosis is the particular density of the discrete commercially far the more important. Its greatest opacities on the x-ray film, this being due to the single use is in the manufacture of lithopone, a high radio-opacity of tin (atomic weight 119 com- white pigment consisting of barium sulphate pared, for example, with iron 56). (66%) and zinc sulphide (34%), which is used in Baritosis due to the inhalation of barium dust paint making. Barium sulphate is also used as an has long been accepted as a benign condition extender or filler for paper, textiles, leather, soap, although the first case to be described (Fiori, rubber, and linoleum. It is used in oil drilling, in 1926) was in a man who had symptoms and was cements and plasters, particularly when high 30 Thorax: first published as 10.1136/thx.31.1.30 on 1 February 1976. Downloaded from Baritosis: a benign pneumoconiosis 31 radio-opacity is required, in ceramics, glass, and was recovered in three grades, one practically electronic valve manufacture. Various barium pure and the others with increasing quantities of salts are used in the chemical and dyestuffs in- impurities. dustries, in sugar refining, in pyrotechnics and Subsequent processes were carried out in the signal lights, and as insecticides and rodenticides; mill. There the two better grades were separately metallic barium has a limited use in the manu- dried in a rotary drier and pulverized in a tube facture of certain alloys. mill. After passing through air separators, from The soluble compounds of barium are highly which insufficiently small particles were returned toxic, the fatal dose of the chloride according to the mill, the material was elevated to a storage to Sollmann (1932) being 08 to 09 g. While it hopper, fed to a mechanical bagging point, and has been used in a few cases of accidental or bagged in paper sacks. The third grade was dried deliberate poisoning in humans, very few cases on a hot plate in the room, the material being of industrial poisoning have been reported. One raked manually more or less continuously. When was described by Kipper (1926) in a worker em- dried, it was shovelled into a large heap and ployed for several days crushing barium peroxide bagged by hand. These processes gave rise to in very dusty conditions. The chief features of large quantities of dust, there being a continual the illness were abdominal pain, vomiting, tachy- haze in the workroom. The main points of dust cardia, dyspnoea, cyanosis, and paralysis of the evolution were the raking and shovelling of the right arm and leg, death occurring on the third material on the hot plate, at mechanical and day. The dust at the mill contained BaO 14% hand bagging, and to a less extent at charging and and BaCO3 38% which, together with the per- discharging the drier. Local exhaust ventilation oxide, were presumably converted into the soluble was provided at the drier and at mechanical chloride in the stomach. bagging but, especially at the latter point, was While barium chloride is readily soluble in poor. No respirators were worn. water (1 : 10), barium sulphate is characterized by its extreme insolubility. One hundred parts of copyright. cold water dissolve only 0 000115 parts of barium 1947 EXAMINATIONS sulphate, and of hot water only 0000285 parts, In 1947, only five of the employees had been with while 100 parts of 3% hydrochloric acid dissolve the firm for more than three and a half years and 0(006 parts. This property, together with its high these were examined. Their ages ranged from 24 radio-opacity, enables it to be used safely as an to 61 (mean 48) years and their exposures to http://thorax.bmj.com/ opaque medium in radiographic examination of barytes 34 to 15 (mean 72) years. Three of the the gastrointestinal, respiratory, and urinary tracts men were completely free of chest symptoms and and sinuses. It would be expected that such an had no abnormal physical signs on examination. insoluble substance would be inert if inhaled The remaining two had slight coughs, in one into the lungs and, as has been stated, most associated with slight sputum and some emphy- descriptions of baritosis stress the absence of sema, and in the other a few basal crepitations symptoms in conjunction with the very marked were present. In one case the chest radiograph radiographic changes. showed increased lung markings and was classed as category Z. There were no discrete opacities in on September 24, 2021 by guest. Protected any of the films and none was thought to show THE PROCESS any evidence of dust retention. In 1947 I visited a small factory where barytes was In 1952, the work had diminished considerably, ground. At that time there were 18 employees being carried out on only two days weekly, and although normally the number was only 12. The I made no examinations then. premises consisted of two rooms, one about 10 7 m (35 ft) square by 3 9 m (13 ft) high called 'the wash', the other about 22 9X18 3X6 1 m 1961 EXAMINATIONS to the eaves (75X60X20 ft), rising to 9 1 m (30 ft) In 1961, grinding was again in progress for five at the apices of the two bays, called 'the mill'. days weekly and, once more, vast quantities of The raw ore was brought to the factory by road dust were being produced. I made clinical in a very moist state, tipped on the floor of the examinations of all 12 workers employed and wash, and charged into a hammer mill by shovel- radiological examinations of 11, one of the men, ling. The heavier material was then separated employed for only a month, having left the from the lighter on a sloping table with a copious employment before being x-rayed. supply of water. By this simple means the barytes These 11 workers comprised eight who had Thorax: first published as 10.1136/thx.31.1.30 on 1 February 1976. Downloaded from 32 A. T. Doig been employed for 3j to 18 (averagei 9) years, 1963 EXAMINATIONS I3 L- . - . only one of whom had been examinecI Dy me n In 1963, 18 months after the 1961 examinations, I 1947. Their ages ranged from 26 to 45 (mean 32)'...32) repeated the clinical and radiological examina- years.
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