Bronchiolitis resulting from the handling of bagasse.

Bagasse is sugar cane after the sugar has been extracted. Because of the toughness of its fibres and their good insulating properties it is used for making boards for interior decorating and for thermal insulating purposes. The sugar cane which is used for this purpose is grown in Louisiana and shipped to to this country in bales. When the bales are packed in America the bagasse contains 4 per cent. of glucose, but on arrival in England it is sugar free. Until the outbreak of war the bales were broken by a wet process: they were placed under water in a soak pit, broken, and then carried by a conveyor belt from the small house in which this process was carried out to the main factory for processing. At the end of 1939, in order to save shipping space, the bales were packed more firmly and it proved no longer possible to break them in this wet process. A machine, known as a shredder, was therefore introduced to break the bales. This consisted of a wheel with multiple blades which revolved inside a case. The bales were first broken with a pick-axe and the sections then thrown into the case. The bagasse was thus shredded by this dry process and the small pieces were carried by the conveyor belt as before. This process proved to be very dusty. Bagasse, as found at the factory, consists mostly of cellulose fibre, though some of the cellulose is present in crystalline form. It also contains 1 per cent. of protein. Nagelschmidt found that bagasse gave 3 per cent. of ash on ashing at 4000 C. By alternating treatment of this ash with cold dilute acid and hot dilute alkalies, over 80 per cent. could be dissolved. This dissolved portion contained the amorphous silica which came to about 50 per cent. of the total ash. The residue contained much quartz. Microscopic and x-ray diffraction analysis put the quartz at about 3-5 per cent. of the total ash. This amorphous silica formed roughly 1-2 per cent. of the bagasse and quartz 0-1-0-2 per cent.; many of the quartz particles were 20-30,u in size. It was most improbable, therefore, that any risk of silicosis could arise in handling bagasse. Bagasse was also found to contain many fungi. J. T. Duncan examined samples and also dust from the shredder room. He found many fungi present, and estimated that one gramme of the airborne dust contained 240 million fungal spores. These consisted of the uncultivable teliospores of fungi of the order Pucciniales (Rusts), as well as the conidia of many species of saprophytic fungi. About 20 different species were isolated in culture, including Paecilomyces varioti, Aspergillus fumigatus, A. niger, A. terreus, and A. candida, Trichoderma lignorum, Monilia sitophilia, Aleurisma sp. and species of Penicillium, Mucor, Rhizopus, etc. In 1940, after the installation of the dry bale breaking machinery, cases of respiratory illness began to appear among employees working the shredding machine and breaking the bales. These cases were observed by Lloyd (1940) at the Brompton Hospital. He considered that he was dealing with an unusual kind of pneumonia which was related to bagasse, but did not think that there was sufficient evidence to establish the aetiology. He consulted E. L. Middleton, H.M. Medical Inspector of Factories who advised that the machinery should be modified by a jet of water being directed on to the wheel to allay the dust. This advice was carried out in 1941, and until 1944 no further case of respiratory disease which could be attributed to the bagasse occurred in England.