Medical Progress - Occupational Medicine - Hardy

Our plain-English summary of Medical Progress - Occupational Medicine - Hardy, by H.L. Hardy (1952).

The study

• Author: H.L. Hardy
• Published: The New England Journal of Medicine, Volume 247 No13. September 25th 1952
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library. The article is still under copyright, so we describe it here rather than post it.

In plain English

This article by Harriet L. Hardy was a review of recent medical literature on occupational disease. It was the first part of a two-part report. It covered occupational infections, occupational cancer, radiation, and lung diseases from dusts including silica, coal, aluminum, talc, graphite and asbestos. On asbestos and lung cancer, the author noted that Vorwald disputed asbestos as a cause of respiratory-tract carcinoma, but wrote that English reports seemed convincing. The author cited a 1947 British report by Merewether of 235 cases of asbestosis with a 13.2 per cent incidence of pulmonary cancer, compared with 1.0 per cent in the general adult population. Two case reports were described: a shipyard worker using asbestos who died with bronchogenic carcinoma, and a man who sorted and carded asbestos fibers for seven years and developed pulmonary adenocarcinoma. The review summarized Saranac Laboratory animal work finding that long rather than short respirable fibers produced asbestosis fibrosis. One asbestosis patient from the author's clinic, treated with ACTH, showed no improvement on lung-function tests. The author called asbestos a potential carcinogen.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: narrative review of recent medical literature on occupational disease (first part of a two-part 'Medical Progress' report), with a few unpublished observations from the author's clinic
• Who was studied: published studies and case reports on occupational disease from the United States, Britain and elsewhere, as available in 1952; occupational skin diseases and general occupational health services were excluded
• Exposure: a wide range of occupational hazards: infections (e.g. anthrax, brucellosis, Q fever), chemical carcinogens (chromate, arsenic, nickel, oils, aromatic amines, asbestos), radiation, and dusts (silica, coal, aluminum, talc, graphite, asbestos)
• Main results:
  • The review reported that Vorwald, in the United States, disputed asbestos as a cause of respiratory-tract carcinoma. The author wrote that English reports seemed convincing.
  • The author cited Merewether's 1947 British report: 235 cases of asbestosis with 13.2 per cent incidence of pulmonary cancer, compared with 1.0 per cent in the general adult population.
  • A case reported by Stoll and associates in 1951: a man exposed for four and one-half years as a shipyard worker using asbestos, who did not wear the mask provided, died about five years later. Asbestos bodies were seen throughout the lung, and a bronchogenic carcinoma with metastases to kidneys, brain and liver was found.
  • A case reported by Iffelbacker et al. in 1952: a man who worked for seven years sorting and carding asbestos fibers intended for insulation manufacturing, with documented dangerous asbestos levels. At autopsy he had extensive pulmonary adenocarcinoma with metastases to the vertebrae.
  • The review reported that the Saranac Laboratory group (Vorwald and co-workers, 1951) found in experimental studies that long rather than short respirable fibers produce the peribronchiolar fibrosis of asbestosis.
  • The Saranac group also found that the action is mechanical and depends on length and intensity of exposure, and that experimental asbestosis stops progressing when exposure stops.
  • The Saranac group found that asbestos bodies result from coating of the fibers. Experimental tuberculosis was not altered by inhaling asbestos fibers.
  • In unpublished experience from the author's Occupational Medical Clinic, 1 case of asbestosis treated with ACTH showed no improvement on pulmonary-function studies before and after treatment.
• The authors' conclusion: The author considered the asbestos lung-cancer cases significant because many asbestos-exposed American workers were in operations the author described as not properly safeguarded against a potential carcinogen.

Topics

Medical terms in this study, explained in our Lexicon: Occupational Disease, Talc, Lung Cancer, Carcinoma, Bronchogenic Carcinoma, Adenocarcinoma, Saranac Laboratory, Respirable Fiber.

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