Silo-Filler's Disease

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Abstract
Since the autumn of 1954, sporadic cases of farmersan unusual pulmonary disease affecting farmers engaged in filling silos have been encountered. The patients presented a clinical picture of acute illness, with coughing exposure and dyspnea, immediately following exposure to acrid fumes arising from fresh silage. The clinical course thereafter showed considerable variation. Experimental evidence, as well as clinical and pathologic similarity to cases of nonagricultural fume exposure, indicates that the noxious gas is nitrogen dioxide. The disease affecting farmers differs from industrial nitrous fume poisoning, a well known entity, only in the manner of exposure. Thirteen cases of silo-filler's disease were found in the medical literature (6, 9, 10, 11, 13, 14, 21). Two these, however, studied by Dickie and cited by Grayson (11), have not yet been reported in detail and are therefore excluded from further consideration because of insufficient information. One case, still under observation by Eckhardt (8), has not yet been published. Thus, detailed information was available in 12 cases in addition to our own. Many more cases have undoubtedly occurred but have not been reported, and it is probable that a large number have not been recognized. Many clinicians, including those in rural areas, are unaware of the disease or are unfamiliar with the possible syndromes it may present. Yet almost any physician may encounter it, since in some cases a latent period of relative normal health, of two or three weeks duration, will enable the victim to travel some distance or even to change his occupation before symptoms appear. The patient may then become seriously or even critically ill within a few days, and the clue of previous fume exposure, so vital to the diagnosis, may have been forgotten. Awareness of the condition on the part of the physician should lead to direct questioning about possible exposure. This is important, since prompt adrenal cortical hormone therapy may be life-saving. Two cases we have encountered are presented to illustrate two different syndromes of the same disease. Case Reports Case I: On the morning of Sept. 10, 1957, a 38-year-old farmer climbed the enclosed ladderway to the top of a silo to level the silage which had been blown in on the previous day. Although the silage blower was in operation, he detected, a bitter, stinging odor in the chute. On descending the chute, he experienced the same sensation, which became more pronounced as he made his way down. About 9 feet from the bottom, he was overcome by the fumes and fell to the floor of the silo room. His brother carried him outside, where he immediately revived. He was short of breath, coughed considerably, and was nauseated but did not vomit. Weakness was pronounced.

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