Health Effects of Inorganic Fibers

Abstract

It has become fashionable to start discussions of disease related to fibrous inorganic materials by referring to Pliny the Younger (A.D. 61-114), who commented in a letter on the sickness of slaves who worked with asbestos. His observation was forgotten, as evidenced by the fact that during the Middle Ages, Paracelsus (1493–1541) as well as Agricola (1494–1556) wrote extensively on “miner’s disease” without mentioning asbestos. Later, Zenker (1867) coined the word pneumo(no)coniosis to describe the diseases endemic to coal and iron miners. Differential diagnosis of the pulmonary disorders, tuberculosis, silicosis, pneumonia, and other lung disease was attempted thereafter, although the varieties were often confused even by experienced physicians. The industry that provided asbestos to modern society started at about this same time (in the 1870s). The first indication of pulmonary disorder in an asbestos worker came in an autopsy report of fibrosis by Dr. Montague- Murray at Charing Cross Hospital, London, in 1899–1900 (Peters and Peters, 1980). By 1902 asbestos was included in the list of dusts considered injurious by the Lady Inspector of Factories, Adelaide Anderson (Oliver, 1902). Auribault (1906) appears to have been the first to note high mortality in workers in an asbestos mill and weaving establishment, but he attributed their illness to calcium carbonate dust rather than asbestos. Scarpa (1908) believed the pulmonary disease of 30 asbestos workers was caused by tuberculosis, and Fahr (1914), who published the case of a female asbestos worker who died of “pleuro-pneumonia . . . with a large number of crystals in pulmonary tissue of a peculiar nature,” was clearly somewhat mystified at the presence of nonbiological materials. It was Cooke (1924, 1927, 1929) who first defined asbestos as a specific etiologic agent in pulmonary fibrosis. He described extensive fibrosis with thickened pleura and adhesions to the chest wall and pericardium in asbestos workers and noted the presence of abundant mineral matter (“curious bodies”), but also tubercular lesions. The term asbestosis was used in the 1927 publication. Pancoast and Pendergrass (1925) argued that the fibrosis seen in asbestos workers was a result of ad-mixed silica and an expression of “asbestosilicosis,” signifying uncertain etiology of the observed symptoms, a view that survivied into the 1930s (Lynch and Smith, 1935).