A histological study of the lungs in 52 cases of chronic beryllium disease.

Abstract

Beryllium disease is a term used to describe the systemic effects of exposure, usually by inhalation, to beryllium and certain of its compounds and it can be subdivided into an acute and a chronic variety. This paper deals with the histological findings in the lungs in chronic beryllium disease. I agree with Hardy (1956) that the alternative term chronic pulmonary beryllium disease is unsuitable as it tends to obscure the essentially systemic nature of the disease, though the primary manifestations are usually in the lung. Beryllium was first identified by Louis Nicolas Vacquelin in 1797. Until recently it was valued only as a component of precious stones but it is now used increasingly in industry, for example, in the pro duction of such metal alloys as stainless steel and chromium and for the screening of uranium in atomic power stations. Other occupations where beryllium is a risk are the making of cathode tubes and x-ray machine windows, ceramics, beryllium extraction from ore, and certain experimental work. Beryllium has not been used since 1948 in the manufacture of fluorescent lamps. Beryllium was soon found to produce toxic effects on inhalation and the earlier papers describe the acute manifestations of a metal-fume type of illness (Weber and Engelhardt, 1933; Fabroni, 1935; Gelman, 1936; Berkovitz and Israel, 1940). One of the earliest North American reports is that of Van Ordstrand, Hughes, and Carmody (1943) who described three acute cases. The earliest reports of a chronic pulmonary disease caused by beryllium came from the U.S.A. (Hardy and Tabershaw, 1946; Gardner, 1946; Higgins, 1947). The disease was the subject of a Saranac Symposium (Vorwald, 1950) and this report provides an excellent summary of knowledge up to that date. Since then a beryllium case registry has been started by Hardy (1955a) which up to date (personal communication) includes 500 cases, 287 chronic and 213 acute, with an overall mortality of 27 %. Very few British cases have been reported. The first was by Agate (1948), an example of the chronic type, in a physicist working with fluorescent lamps. Royston (1949) has reported the only acute case to occur in Britain. Sneddon (1955) described a chronic case in a woman of 25 working with 2% beryllium-copper alloy. The only other report in the British literature is of a skin granu loma caused by a fluorescent tube fragment (Lederer and Savage, 1954). There are two other unpublished British chronic cases, namely, by Teare (1955) in a fluorescent lamp worker and by Rannie (1956) in an experimental chemist.