Delayed Chemical Pneumonitis or Diffuse Granulomatosis of the Lung Due to Beryllium

Abstract

A more suitable title for this presentation would have been, “Pulmonary Changes Occurring Among Beryllium Workers.” Sufficient evidence seems to have accumulated for us to consider beryllium or its compounds to be etiological factors; still, absolute proof of this assumption is not yet available. It was necessary, first of all, to prove that beryllium is toxic in the amounts and compounds to which the individuals were exposed. Next, the opportunity for exposure had to be established, and all other causative factors ruled out. Third, the cases had to show a similarity of clinical findings, roentgen pattern, and pathological changes postmortem. Fourth, the suspected toxic agent had to be shown to be present in the tissue. Fifth, the disease must be produced experimentally in animals, if possible. These conditions have all been fulfilled, with the possible exceptions of ruling out other causative agents and producing identical lesions in the lungs of animals exposed to this element. Experimentation has, however1 now reached a point where it may be possible to meet these requirements as well. Opportunity for exposure to beryllium starts in the beryl mines. In plants engaged in extracting beryllium from the ore and in the production of beryllium salts and oxides there has been definite evidence of disease among employees. The same has been true in metallurgical plants where beryllium has been used as a constituent in the production of alloys. Cases have been reported where the phosphors that are used in coating fluorescent lamps and neon tubes were being processed. Others have been discovered where the lamps were manufactured and where neon tubing was being bent. At least one case has arisen in the radio tube industry, and a few where the metal or its oxide was being ground. Beryllium or its compounds may be found in chemical and pharmaceutical plants. It is a possible hazard in research laboratories. Its use has been reported where gas mantles and some ceramics are made. There are undoubtedly many other instances which have not been uncovered. It must be noted that not all of these industries have experienced the development of pulmonary disease among their workers. In those that have, the symptomatology, x-ray pattern, and pathology have been so similar that a common denominator is suspected, this denominator being beryllium or one of its compounds. In reviewing the literature regarding the toxicity of this substance, one is quite surprised to find a number of articles dealing with the subject. Most of these appear in European journals between 1933 and 1942. Very little beryllium was being used in America prior to the recent war. It was not brought to the attention of the medical profession until 1943. In that year, under the title, “Chemical Pneumonia in Workers Extracting Beryllium Oxide,” Van Ordstrand, Hughes, and Carmody reported three cases in the Cleveland Clinic Quarterly (1).