Hard metal disease.

In Great Britain there have been no published reports of respiratory disease occurring amongst workers in the hard metal (tungsten carbide) industry. In this paper the clinical and radiological findings in six cases and the pathological findings in one are described. In two cases physiological studies indicated mild alveolar diffusion defects. Histological examination in a fatal case revealed diffuse pulmonary interstitial fibrosis with marked peribronchial and perivascular fibrosis and bronchial epithelial hyperplasia and metaplasia. Radiological surveys revealed the sporadic occurrence and low incidence of the disease. The alterations in respiratory mechanics which occurred in two workers following a day's exposure to dust are described. Airborne dust concentrations are given. The industrial process is outlined and the literature is reviewed. The toxicity of the metals is discussed, and our findings are compared with those reported from Europe and the United States. We are of the opinion that the changes which we would describe as hard metal disease are caused by the inhalation of dust at work and that the component responsible may be cobalt.