Massive Pulmonary Fibrosis from the Inhalation of Talc

Abstract

It is generally accepted that the inhalation of commercial talc powders can occasionally produce pulmonary disease. This is usually fibrosis of a nodular type, and only a few examples of massive fibrosis have been reported, most of them without pathological description. This is the report of one such case showing certain unusual features.CASE REPORT INDUSTRIAL HISTORY.-The patient was 57 years old at his death. He joined the Army at the age of 16, at the start of the first world war. During this war he was gassed, although not severely. When he left the Army he became a storekeeper in a food store. In 1927, at the age of 29, he first entered the accumulator industry. For the first six years he was employed in lead burning, and was not exposed to dust. After this he joined another firm as a plate caster. The following 10 years, i.e., between the ages of 35 and 45, was the only period during which he was exposed to dust. Lead accumulator plates were cast in a hand-operated mould consisting of two faces hinged at the bottom. There were two men casting in one small room, each with his own mould and with a communal gas-fired lead pot. The mould was at about waist height. It was opened, and then each surface was roughly dusted with talc from a loosely woven calico bag or an old sock. The bag was banged hard against the mould and a cloud of dust would arise. Next, the mould was closed and the lead poured in. It was cooled with water and opened and the plate removed. The sequence was then repeated. The patient was a good workman and cast up to 110 plates an hour, being paid piece rates. The talc bag contained about three-quarters of a pound of talc, and about three bags were used in two days.

The biology of talc.

“…Published cases of talc pneumoconiosis, therefore, primarily concern subjects engaged in the mining or processing of talc and usually refer to data obtained before modern mining and environmental standards were implemented (Dreessen, 1933;Dreessen and Dalla Valle, 1935;Porro, Patton, and Hobbs, 1942;Greenburg, 1947;Millman, 1947;Hogueand Mallette, 1949;McLaughlin, 1950;Jaques and Benirschke, 1952;Alivisatos, Pontikakis, and Terzis, 1955;Kleinfeld, Messite, and Tabershawe, 1955;Schepers and Durkan, 1955a;Hunt, 1956;Nagelschmidt, 1960;DeVilliers, 1961;Coscia et al, 1963;Gaido, Capellaro, and Delmastro, 1963;Scansetti, Rasetti, and Ghemi, 1963;Dettori, Scansetti, and Gribaudo, 1964;Kleinfeld et al, 1964aKleinfeld et al, , b, 1965Kleinfeld et al, , 1967Kleinfeld et al, , 1973Graham and Gaensler, 1965;Weiss and Boettner, 1967;Fristedt, Mattsson, and Schutz, 1968;El-Ghawabi, El-Samra, and Mehasseb, 1970;Kleinfeld, 1970;Selikoff, 1973;Wegman et al, 1974). In people not employed in the talc industry, only isolated cases of pulmonary changes have been reported where there was either accidental exposure or excessive usage of talc (Jacobziner and Raybin, 1963;Jenkins, 1963;Gouvea et al, 1966;Zientara and Moore, 1970;Atlee, 1972;Nam and Gracey, 1972).…”

Case 21-1999

“…Talc and other silicates tend to cause intense vascular inflammation and sclerosis, which contributes to the pulmonary scarring. 15,[43][44][45] There were no compact granulomas, the presence of which would have suggested infection, nor were any organisms detected with special stains. Pneumocytes in areas of scarring were reactive and atypical, probably accounting for the cytologic diagnosis of adenocarcinoma.…”

“…41,43 Areas of massive fibrosis can appear radiographically as central or peripheral masses, and in some cases, they have been resected surgically. 41 Impacted talc was found to have plugged and destroyed bronchioles in a child who died after aspirating talcum powder.…”

“…15,41,47 Rubber workers are now probably the most commonly exposed persons. 41,43,48,49 DR. DAVID J. KANAREK: This patient worked in eastern Massachusetts for 28 years, making bands eight hours a day, and every time he made a rubber band, he sprayed it with talc. Then he moved to Arizona.…”

Talco-Silicosis in a Rubber Worker

“…Am ong th e new er hazards are th e resorcinol-form aldehyde ty p e resins which are used to bond th e nylon fabric to th e tread of high-speed tires: and th e shift from foam ru b b e r to polyurethane foam has caused diiso cy an ate (TDY) lung disease. O ur p a tie n t was exposed not only during th e shredding and grinding operation b u t for 8 years before th a t he m ade storage b a tte ry plates an d casings, an occupation which, under th e term " accum ulator plate casting" has been associated w ith ta l cosis [12]. F urtherm ore, some tim e ago w hiting, in addition to pyrop h yllite, was used in rubber-reclaim ing operations and this contained 65 per cent q u artz [2].…”