AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 58:S67–S71 (2015)

Historical Perspective

Historical and Emerging Workplaces Affected by

Silica Exposure Since the 1930 Johannesburg
Conference on Silicosis, With Special
Reference to Construction

, 
Jean-FranSc ois Sauve MSc, BSc (Ag. Env. Sc.)

Introduction At the time of the 1930 International Labour Office Conference on silicosis
in Johannesburg, mining was the main sector affected by silicosis; however, other
industries would later emerge as areas of concern.
Methods A search of the occupational hygiene and epidemiological literature was
conducted to retrieve historical and current documents pertaining to silica exposure and
associated hazards.
Results The potential risk of silicosis in construction became evident starting in the
1960s, and the body of literature including case reports, sampling surveys, and medical
surveillance continues to grow to this day. Among non-construction activities, hydraulic
fracturing and engineered countertop manufacturing have recently appeared as industries
with a potential for overexposure, while mining remains the industrial sector with the
highest prevalence of exposure.
Conclusions The risk of developing this “ancient disease” remains a current issue in
many workplaces, and requires ongoing surveillance and prevention efforts. Am. J. Ind.
Med. 58:S67–S71, 2015. ß 2015 Wiley Periodicals, Inc.

KEY WORDS: occupational diseases; silicosis; history of silicosis; silica exposure;

construction industry

INTRODUCTION silicosis, but also touched on broader aspects surrounding

The 1930 International Labour Office (ILO) Conference
on silicosis in Johannesburg was a landmark event which not
only led to the first international consensus definition of
Department of Environmental and Occupational Health, School of Public Health, Uni-
versit
e de Montr
eal, Montr
eal, Qu
ebec, Canada

Correspondence to: Jean-FranSc ois Sauv
e, MSc, BSc (Ag. Env. Sc.), 850, rue St-
Denis, room S02-348, Montr
eal, Qu
ebec H2X0A9, Canada.
E-mail: jean-francois.sauve@umontreal.ca
Accepted 9 July 2015
DOI 10.1002/ajim.22507. Published online in Wiley Online Library
(wileyonlinelibrary.com).
this disease such as diagnosis, patient care, compensation,
and methods to control exposure. The conference
proceedings—both in the discussions and in the papers
presented—also provide an overview of the industrial sectors
affected by silicosis across the different countries repre-
sented at this forum, with many of these sectors still being
sources of cases over 8 decades later.
Throughout the discussions held at the conference, silica
exposure and silicosis in mining and quarrying work held a
predominant place. The fact that respiratory ailments
associated with mining activities has been documented going
back to antiquity [Rosen, 1943; Corn, 1980] and the location
of the conference—South Africa, with a substantial gold

ß 2015 Wiley Periodicals, Inc.

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Sauve
mining industry—drove the attention to this sector in the
discussions. In the 8 decades that followed the conference,
numerous epidemiological studies have been conducted on
cohorts of miners. Such studies have been instrumental in
characterizing the risk of silicosis [e.g., Steenland and Brown,
1995a] and in identifying other diseases associated with silica
exposure, such as lung cancer [IARC, 1997,2012] and non-
respiratory diseases [Steenland and Brown, 1995b; Calvert
et al., 1997; De Klerk et al., 2002]. Recent exposure
surveillance data continue to demonstrate the potential for
silica dust overexposure in the mining sector, especially in
underground operations [Hayumbu et al., 2008; Watts et al.,
2012; Scarselli et al., 2014].
References to other industries and occupations affected
by silicosis are also found in the proceedings. These include
metal grinding, potteries, stonemasonry, foundries, refracto-
ries, and abrasive blasting, with some concentration within
countries, such as the importance of porcelain manufacturing
in Germany [B€ ohme, 1930]. Silicosis continues to be a threat
in some of these other industrial sectors despite the fact that
methods are available to protect workers from harmful
exposures. For example, the use of sand in abrasive blasting
has been banned in most European countries for decades
[Madl et al., 2008]. Yet, clusters of silicosis cases among
sandblasters in the oil drilling industry appeared in Texas in
the late 1980s [CDC, 1990] and, more recently, in Turkey,
associated with the practice of denim sandblasting [Akgun
et al., 2008]. Such cases could have been prevented using
appropriate protection and especially using alternative
blasting materials.
Another major industry where the prevention of silica
exposure and silicosis is a current concern today is
construction. However, this sector received little attention
at the conference, and its importance would appear only
several decades later. The objective of this article is to
provide an overview of the importance of the silica hazard in
construction and how it came to be recognized. Other
industries affected by silicosis that have emerged since the
1930 ILO Conference on silicosis are also briefly discussed.
EMERGING AWARENESS OF THE SILICA
HAZARD IN CONSTRUCTION
Although the problem of silicosis had by 1930 been
recognized in many industries, there was scant mention
of the silica hazard associated with construction work in the
discussions and papers presented in Johannesburg. There
was reference to stonemasonry [Kranenburg, 1930] and
the aforementioned abrasive blasting. Albert E. Russell’s
paper “Silicosis in the United States” refers to findings of
silicosis cases associated with the tunnel excavation for the
New York City subway, and reports an estimated 20,000
workers potentially at risk of silicosis on this project
[Russell, 1930]. However, the hazards of tunnel construction
really came to light a few years later with the Hawk’s
Nest tunnel disaster in West Virginia, where a total of
2,500 workers were involved in the digging of a pair of
tunnels as part of a hydroelectric project. Even though the
duration of exposure was very short (80% of workers were
employed for 6 months or less), it is estimated that at least
2,000 workers contracted silicosis, with 764 workers dying
from the disease. The disaster was due to the extremely rich
silica content of the rock (from 96 to 99% silica) and the
lack of dust control methods and respiratory protection
[Cherniack, 1986]. Some processes and work environments
associated with tunnel construction are the same as those in
underground mining, as is the potential for silica exposure,
and should thus be easier to anticipate. Yet, controlling silica
exposure in tunnel excavation remains a challenge today, as
illustrated by reports of overexposure during the construction
of an extension of the subway in New York City in 2011
[Fermino, 2012].
Excepting the early reports of silicosis linked with
tunnel construction work, the recognition of the silica hazard
associated with other construction activities evolved slowly.
Indeed, in a review published in 1961 [Magnuson, 1961],
silica was mentioned as a hazard only for tunneling work. A
year later, a survey provided indications of the risk of
excessive silica exposure in highway and dam construction,
in addition to tunneling operations [Burns et al., 1962].
Hazards linked with concrete work started being recognized
in the early 1970s with cases of silicosis associated with
concrete finishing and demolition reported in France
[Bernardou et al., 1970; Sors et al., 1972]. By the end of
the decade, construction occupations with intermittent or
bystander exposure to silica, such as welders and elec-
tricians, were being acknowledged [Thomas, 1979]. In 1982,
a comprehensive investigation encompassing several con-
struction tasks and dust suppression methods available was
conducted in Sweden [Hallin, 1983]. This study concluded
that the dust suppression achieved with these methods was
often insufficient to achieve acceptable levels of exposure for
many of the tasks evaluated.
By the 1990s, the hazard of silica exposure in
construction became more broadly recognized [Lofgren,
1993; Linch and Cocalis, 1994]. Many research studies
conducted since then have documented the potential of
overexposure in a wider range of construction occupations
and tasks [Lumens and Spee, 2001; Rappaport et al., 2003].
The recognition of the importance of silica exposure in
construction can be seen in the prevalence estimates
developed for the Global Burden of Disease project, where
the construction industry had the second highest estimated
proportion of workers exposed (19%) after mining (23%)
[Driscoll et al., 2004].
In addition to exposure surveillance, other investiga-
tions have focused on disease surveillance among workers
 Historical and Emerging Workplaces Affected by Silica Exposure Since 1930
employed in the construction sector. For example, a study of
respiratory function of 7,457 construction workers in the
Paris region found a higher prevalence of respiratory
symptoms among workers with past and current exposure
to silica than those without such exposure [Blaizot et al.,
1970]. In a later study of 271 Swedish concrete workers
[Tornling et al., 1992], no silicosis was found, although a few
cases of radiographic abnormality were observed. Finally, a
large study of 1,335 Dutch construction workers found a
prevalence of radiographic abnormalities of 10.2%, and
decreased lung function compared to a population of non-
construction workers [Tjoe-Nij et al., 2003].
Despite the widespread exposure to silica in construc-
tion, surveillance and prevention of exposure and its
associated diseases in this sector remain a challenge, notably
due to the specialized and highly mobile workforce and the
temporary nature of construction sites. Construction firms
also tend to be relatively small: as an example, over 80% of
construction firms in Qu
ebec comprise five employees or
fewer [Commission de la construction du Qu
ebec, 2014]. In
addition, the silica content of building materials tends to
be quite variable, which also complicates the process of
identifying workers at risk and preventing harmful expo-
sures. The 1930 Conference brought together the experts of
the time and the available evidence to tackle the complex
problems of silicosis and its prevention. Similarly, address-
ing the complexity of exposure in the construction industry
also requires collaborative efforts. The advancements in
technology, communications, and statistics over the last
80 years have facilitated the rapid dissemination and
collection of evidence, allowing, for example, the creation
and analysis of databases combining measurement data
reported in the literature.
Such a strategy was adopted by Flanagan et al. [2006],
following a call made in 2001 to the research and industrial
hygiene community to collect silica sampling results related
to miscellaneous construction activities [Becker et al., 2001].
A total of 1,374 quartz measurements spanning 16 tasks
categories were obtained and analyzed. The authors
concluded that overexposure was prevalent while respiratory
protection was seldom used, and that additional surveys
would be needed to document exposure levels for less
prevalent tasks and occupations. Building in part on the
framework used by this project, Beaudry et al. [2013]
developed a database representing over 10,000 measure-
ments from 11 countries, following collaboration with The
National Institute for Occupational Safety and Health
(NIOSH), France’s Institut de Veille Sanitaire and the
researchers behind the 2006 database project. Measurement
data published in research reports and journal articles were
also extracted in order to attempt to encompass as many
circumstances associated with silica exposure as possible.
This project enabled the production of descriptive
portraits of silica exposure for several trades, tasks and tools,
S69
and the assessment of different methods to control dust
exposure. For the latter, water or ventilation represent the
primary strategies to control exposures, as discussed at the
1930 Conference. The combination of exposure data within a
single database allowed for the development of statistical
models, which in turn enabled the estimation of the exposure
levels based on the task performed, characteristics of the
work environment, and types of control methods, among
others [Sauv
e et al., 2012, 2013]. The information provided
can henceforth facilitate the identification of situations of
potential overexposure and methods suited to their preven-
tion. Thus, the spirit of increased international collaboration
that was fostered at the 1930 Conference lives on, although
such collaboration can now takes more indirect forms.
Finally, the development of methods to control expo-
sure, for example, the use of additives to improve dust
suppression on concrete saws [Summers and Parmigiani,
2015], remains an active field of research. In addition, the
scope of the investigations have been broadened to include
managerial, organizational, and psychosocial factors, such as
culture and risk perception, to improve interventions aimed
at controlling silica exposure [van Deurssen et al., 2014].
Efforts have also been made to develop low-cost screening
tests for silicosis adapted to construction workers, by
combining questionnaire and lung function assessment
data for purposes of disease surveillance and prevention
[Suarthana et al., 2007].
CURRENT AREAS OF CONCERN AND
PERSPECTIVES FOR PREVENTION
The objective of eliminating silicosis has been proposed
for decades, such as in 1978 [Harry and Ohman, 1978] and,
more recently, by the International Labour Organization and
the World Health Organization [2007]. Still, silica exposure
remains a concern in many occupations. Some of the risks
faced today hark back to equivalent hazards at the time when
the Conference was held, such as in the relatively recent
cases of abrasive blasting and the extension of the New York
City subway mentioned earlier. Other risks appeared not
long after the conference, such as silicosis among dental
technicians [Siltzbach, 1939], with cases still being reported
in the United States in the 1990s [CDC, 2004]. In other cases,
risk originally confined to a small subset of an industry,
namely construction with stone masonry, now affects
workers involved in a wide range of building trades due to
the widespread use of materials containing silica. The
hazards of highway construction, identified in the 1960s,
now extend to highway repair as the road infrastructure ages
and requires maintenance [Valiante et al., 2004].
Finally, new processes and materials leading to silica
exposure are still emerging. One example outside the
construction industry is the manufacture of engineered (or
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Sauve
artificial stone) countertops, which are cheaper to produce
than granite tops but contain a much higher proportion of
silica—over 90% relative to less than 50% for granite.
Silicosis cases due to the manufacture and installation of
these components have been described in the literature in
recent years [Kramer et al., 2012; P
erez-Alonso et al., 2014],
and this sector was the focus of a recent hazard alert from the
Occupational Safety and Health Administration (OSHA) and
NIOSH [OSHA and NIOSH, 2015]. Another emerging risk
activity is hydraulic fracturing in the oil and gas industry,
where the handling of large quantities of sand can expose
workers to high concentrations of silica on well sites
[Esswein et al., 2013].
CONCLUSION
Many of the sectors carrying a danger of silicosis
identified 80 years ago at the 1930 Conference remain a
concern today. Ongoing medical and exposure surveillance,
and implementation of interventions to manage and control
exposure, are warranted to prevent new cases of silicosis and
other diseases associated with silica. In the case of
construction, this includes ongoing research in engineering
control methods and in developing prevention strategies that
can be adapted to a variety of worksites. Finally, emerging
hazards of silica exposure underline the need for sustained
vigilance to anticipate new or evolving tasks and processes
where silica exposure might occur.
ACKNOWLEDGMENTS
The author wishes to thank Charles Beaudry, Denis
B
egin, Michel G
erin, and J
er^ome Lavou
e, plus two
anonymous referees, for their helpful comments and
suggestions. The author was supported by the Fonds de
Recherche du Qu
ebec—Sant
e and the Institut de recherche
Robert-Sauv
e en sant
e et en s
ecurit
e du travail.
REFERENCES
Akgun M, Araz O, Akkurt I, Eroglu A, Alper F, Saglam L, Mirici A,
Gorguner M, Nemery B. 2008. An epidemic of silicosis among former
denim sandblasters. Eur Respir J 32:1295–1303.
Beaudry C, Lavou
e J, Sauv
e J-F, B
egin D, Senhaji M, Perrault G, Dion
C, G
erin M. 2013. Occupational exposure to silica in construction
workers: A literature-based exposure database. J Occup Environ Hyg
10:71–77.
Becker P, Flanagan ME, Akladios M. 2001. Development of an ACGIH
construction industry silica exposure database overview. Appl Occup
Env Hyg 16:781–783.
Bernardou J, Fr
eour P, Monmayou R, Cloteau J. 1970. La silicose dans les
professions du b
eton. Arch Mal Prof Med Trav Secur Soc 31:617–624.
Blaizot M, Honnet P, Laffont H, Ravault J, Ravault-Chabrat M. 1970.
Enqu^ete sur les risques de silicose et d’asbestose et leurs cons
equences
chez les ouvriers du b^atiment et des travaux publics de la r
egion
parisienne. Arch Mal Prof Med Trav Secur Soc 31:78–80.
B€ohme A. 1930. Silicosis in Germany. 1: Present state of the silicosis
problem in Germany. In: Silicosis. Records of the International
Conference Held at Johannesburg, 13–27 August 1930. Geneva:
International Labor Office. Op. cit. pp. 339–368.
Burns C, Ottoboni F, Mitchell HW. 1962. Health hazards and heavy
construction. Am Ind Hyg Assoc J 23:273–281.
Calvert GM, Steenland K, Palu S. 1997. End-stage renal disease among
silica-exposed gold miners: A new method for assessing incidence
among epidemiologic cohorts. J Am Med Assoc 277:1219–1223.
Centers for Disease Control and Prevention (CDC). 1990. Silicosis:
Cluster in sandblasters—Texas and occupational surveillance for
silicosis. Morb Mortal Wkly Rep 39:433–437.
Centers for Disease Control and Prevention (CDC). 2004. Silicosis in
dental laboratory technicians—Five states, 1994–2000. Morb Mortal
Wkly Rep 53:195–197.
Cherniack M. 1986. The Hawk’s Nest incident: America’s worst
industrial disaster. New Haven: Yale University Press.
Commission de la construction du Qu
ebec (CCQ). 2014. Statistiques
annuelles de l’industrie de la construction 2013. Montr
eal: Commission
de la construction du Qu
ebec, Direction de la recherche et de la
documentation.
Corn JK. 1980. Historical aspects of industrial hygiene-II. Silicosis. Am
Ind Hyg Assoc J 41:125–133.
De Klerk NH, Ambrosini GL, Musk AW. 2002. Crystalline silica
exposure and major health effects in Western Australian gold miners.
Ann Occup Hyg 46(Suppl 1):1–3.
€ un A, Nelson DI, Leigh J. 2004.
Driscoll T, Steenland K, Pr€uss-Ust€
Occupational carcinogens: Assessing the environmental burden of
disease at national and local levels. Geneva: World Health Organization.
Esswein EJ, Breitenstein M, Snawder J, Kiefer M, Sieber WK. 2013.
Occupational exposures to respirable crystalline silica during hydraulic
fracturing. J Occup Environ Hyg 10:347–356.
Fermino J. 2012. Lung hazard at 2nd Ave. Subway. New York Post.
March 19:2.
Flanagan ME, Seixas N, Becker P, Takacs B, Camp J. 2006. Silica
exposure on construction sites: Results of an exposure monitoring data
compilation project. J Occup Environ Hyg 3:144–152.
Hallin N. 1983. Occurrence of quartz in the construction sector; an
investigation of the occurrence of quartz dust in connection with various
operations in the construction sector. Stockholm: Byggh€alsan.
Harry K, Ohman G. 1978. Prevention of silica exposure and elimination
of silicosis. Am Ind Hyg Assoc J 39:847–859.
Hayumbu P, Robins TG, Key-Schwartz R. 2008. Cross-sectional silica
exposure measurements at two Zambian copper mines of Nkana and
Mufulira. Int J Occup Environ Health 5:86–90.
International Agency for Research on Cancer (IARC). 1997. Silica and
some silicates, coal dust and para-aramid fibrils. IARC Monographs on
the Evaluation of Carcinogenic Risks to Humans, Vol. 68. Lyon: IARC.
pp. 41–242.
International Agency for Research on Cancer (IARC). 2012. Silica dust,
cystalline, in the form of quartz or cristobalite. IARC monographs on
the evaluation of carcinogenic risks to humans: Arsenic, metals, fibres,
and dusts, Vol 100C. Geneva: WHO Press. pp. 355–405.
International Labour Office. 1930. Silicosis. Records of the
International Conference held at Johannesburg 13–27 August 1930.
(Studies and Reports Series F Industrial Hygiene No. 13). United
Kingdom: International Labour Office (Geneva), 1930. http://www.
 Historical and Emerging Workplaces Affected by Silica Exposure Since 1930
ilo.org/public/libdoc/ilo/ILO-SR/ILO-SR_F13_engl.pdf (Accessed
May 1, 2015).
Kramer MR, Blanc PD, Fireman E, Amital A, Guber A, Rhahman NA,
Shitrit D. 2012. Artificial stone silicosis: Disease resurgence among
artificial stone workers. Chest 142:419–424.
Kranenburg WRH. 1930. Silicosis in the Netherlands. In: Silicosis.
Records of the International Conference Held at Johannesburg, 13–27
August 1930. Geneva: International Labor Office. Op. cit. pp. 512–534.
Linch KD, Cocalis JC. 1994. An emerging issue: Silicosis prevention in
construction. Appl Occup Env Hyg 9:539–542.
Lofgren D. 1993. Silica exposure for concrete workers and masons.
Appl Occup Env Hyg 8:832–836.
Lumens MEGL, Spee T. 2001. Determinants of exposure to respirable
quartz dust in the construction industry. Ann Occup Hyg 45:585–595.
Madl AK, Donovan EP, Gaffney SH, McKinley MA, Moody EC,
Henshaw JL, Paustenbach DJ. 2008. State-of-the-science review of the
occupational health hazards of crystalline silica in abrasive blasting
operations and related requirements for respiratory protection. J Toxicol
Environ Health B Crit Rev 11:548–608.
Magnuson HJ. 1961. Health hazards in the construction industry.
J Occup Med 3:321–325.
Occupational Safety and Health Administration (OSHA) and National
Institute for Occupational Safety and Health (NIOSH). 2015. Hazard
alert: Worker exposure to silica during countertop manufacturing,
finishing and installation: U.S. Occupational Health and Safety
Administration, National Institute for Occupational Safety and Health.
P
erez-Alonso A, C
ordoba-Do~na JA, Millares-Lorenzo JL, Figueroa-
Murillo E, Garc
ıa-Vadillo C, Romero-Morillo J. 2014. Outbreak of
silicosis in Spanish quartz conglomerate workers. Int J Occup Env
Health 20:26–32.
Rappaport SM, Goldberg M, Susi P, Herrick RF. 2003. Excessive
exposure to silica in the US construction industry. Ann Occup Hyg
47:111–122.
Rosen G. 1943. The history of miners’ diseases: A medical and social
interpretation. New York: Schuman’s.
Russell AE. 1930. Silicosis in the United States. In: Silicosis. Records
of the International Conference Held at Johannesburg, 13–27
August 1930. Geneva: International Labor Office. Op. cit. pp. 535–565.
Sauv
e J-F, Beaudry C, Begin D, Dion C, G
erin M, Lavou
e J. 2012.
Statistical modeling of crystalline silica exposure by trade in the
construction industry using a database compiled from the literature.
J Environ Monit 14:2512–2520.
Sauv
e J-F, Beaudry C, B
egin D, Dion C, G
erin M, Lavou
e J. 2013.
Silica exposure during construction activities: Statistical modeling
of task-based measurements from the literature. Ann Occup Hyg
57:432–443.
S71
Scarselli A, Corfiati M, Marzio DD, Iavicoli S. 2014. Evaluation of
workplace exposure to respirable crystalline silica in Italy. Int J Occup
Environ Health 20:301–307.
Siltzbach LE. 1939. The silicosis hazard in mechanical dentistry. J Am
Med Assoc 113:1116–1119.
Sors G, Cabasson Y, Delplace Y, Tufel Cl. 1972. Silicose pulmonaire
chez des ouvriers du b^atiment et des travaux publics. Arch Mal Prof
Med Trav Secur Soc 33:301–305.
Steenland K, Brown D. 1995a. Silicosis among gold miners: Exposure-
response analyses and risk assessment. Am J Public Health
85:1372–1377.
Steenland K, Brown D. 1995b. Mortality study of gold miners exposed
to silica and nonasbestiform amphibole minerals: An update with 14
more years of follow-up. Am J Ind Med 27:217–229.
Suarthana E, Moons KGM, Heederik D, Meijer E. 2007. A simple
diagnostic model for ruling out pneumoconiosis among construction
workers. Occup Environ Med 64:595–601.
Summers MP, Parmigiani JP. 2015. A water soluble additive to suppress
respirable dust from concrete-cutting chainsaws: A case study. J Occup
Environ Hyg 12:D29–D34.
Thomas C. 1979. Les pneumoconioses dans le b^atiment et les travaux
publics. Arch Mal Prof Med Trav Secur Soc 40:123–126.
Tjoe-Nij E, de Meer G, Smit J, Heederik D. 2003. Lung function
decrease in relation to pneumoconiosis and exposure to quartz-
containing dust in construction workers. Am J Ind Med 43:574–583.
Tornling G, Tollqvist J, Askergren A, Hallin N, Hogstedt C. 1992. Does
long-term concrete work cause silicosis? Scand J Work Environ Health
18:97–100.
Valiante DJ, Schill DP, Rosenman KD, Socie E. 2004. Highway repair:
A new silicosis threat. Am J Public Health 94:876–880.
van Deurssen E, Pronk A, Spaan S, Goede H, Tielemans E, Heederik D,
Meijster T. 2014. Quartz and respirable dust in the Dutch construction
industry: A baseline exposure assessment as part of a multidimensional
intervention approach. Ann Occup Hyg 58:724–738.
Watts WF, Huynh TB, Ramachandran G. 2012. Quartz concentration
trends in metal and nonmetal mining. J Occup Environ Hyg 9:720–
732.
World Health Organization (WHO). 2007. The global occupational health
network newsletter: Elimination of silicosis. Issue No. 12-2007. Geneva:
World Health Organization. http://www.who.int/occupational_health/
publications/newsletter/gohnet12e.pdf (Accessed June 16, 2014).
Disclosure Statement: The author reports no conflicts of interests.
J.F.S. performed the research and drafted the manuscript.