Volume 18, Number 6
Oct 1994

Mold as a Threat to Human Health

Librarians and archivists who work with old books and papers are exposed to a wide variety of molds and other microorganisms, some of which are known causes of disease. Some of those diseases are chronic, some fatal. They can affect anyone, whether or not they have been previously sensitized to the organism.

Yet few precautions are taken in this country, as a rule, to minimize exposure, and most cases very likely go undiagnosed, because the initial symptoms often mimic the flu. Most people confuse such diseases with the allergic reactions produced by pollen and spores blowing in the air. So far there seem to have been no systematic studies of the prevalence and effect of fungal diseases among library and archival workers, though there has been a fair amount of research on mold in library materials--identifying the species, exploring ways to remove the stains, preventing the growth of the fungi, and so on. There have also been epidemiological studies of illness caused by specific molds in industries where a large number of workers deal with a limited number of materials, such as bagasse in sugar mills, and where workers are infected (or affected) by the same organism at the same time. It would be much harder to carry out such a public health study in a collection-holding institution, where there are many species of disease-causing microorganisms, which may be indigenous or may have come into the building from anywhere in the world, and where there are too few people to make up a good statistical sample.

Awareness may be increasing, however, as the result of a lawsuit filed by employees of a SoHo museum. (See related story in this issue.)

The ILO Encyclopedia of Occupational Hazards, in an edition published about 1981, did not mention old books and paper as sources of pathogens in its article on "Airborne Micro-organisms in the Workplace," and did not mention any health risks besides allergic reactions. It did discuss preventive measures, saying that the best thing to do was to discard the material, because it was so hard to separate the pathogen from it. Air conditioners and ducts should be kept clean, and pure water used; good ventilation should be provided. UV sterilization was not recommended because a) it does not affect spores, and b) it generates ozone, which is toxic. Dust masks are not normally recommended, it says, because they offer little protection and are uncomfortable; people who get sick should change jobs.

It is well to remember that "the dose makes the poison"--i.e., that a small or brief exposure is not nearly as likely to make you sick as exposure to heavy concentrations of the organism and/or its toxins, over an extended period of time. It is also true that some people are unusually sensitive to certain allergens or infectious fungi, and that it is hard to establish which species a person is reacting to--in fact, it is often hard to establish whether one is reacting to a fungus at all in any given instance, because fungi are not the only source of airborne disease. There are viruses, like the hantavirus that caused the outbreak recently in the Four Corners area; bacteria, like the thermophilic actinomycetes in contaminated air ducts in buildings; protozoa; and dust mites. And there are nonliving sources as well: the pollutant gases that EPA regulates, toxins produced by microorganisms, metal dusts, gases emanating from the building itself, like radon and formaldehyde, and so on.

The American Medical Association's Family Medical Guide (1987 edition) discusses "Fungal Diseases of the Lungs" on p. 571, saying that there are several diseases that are caused by fungi, and they primarily infect the lungs. They include blastomycosis, cryptococcosis, histoplasmosis and coccidioidomycosis. (The fungus causing the last of these diseases is found, oddly enough, in semi-arid desert soil.) Fungal diseases (mycoses) often clear up without treatment, but may spread throughout the body in the bloodstream and cause dangerous complications. Sometimes there are no symptoms; sometimes there are flu-like symptoms; and sometimes a rash, ulcer or warts may appear on the skin. The infection may settle in parts of the body not directly exposed to the pathogen: the menenges (membranes surrounding the brain), liver, prostate gland or other organs. The good news is that such infections, if properly diagnosed, can be treated with intravenous or other antifungal medication.

Anecdotes from the Field

People have been comparing their personal experiences on the Conservation Distribution List lately. Yulia P. Nyuksha of the Library of the Russian Academy of Sciences in St. Petersburg, has often written on this subject. Last March she commented in the Cons DistList, "One of the sources of professional health problems among librarians may be mycoses of lungs and skin. Certain fungi, molds and their spores are spread very widely in library collections, and all of them are potentially dangerous to humans. American standards list many of these fungi as dangerous."

On the DistList, a discussion was recently initiated by a Tennessee archivist and rare book librarian, who has had increasingly violent, long-lasting headaches that do not respond to medication but which do go away when she is away from work for significant periods of time. Her two predecessors, both nonsmokers, developed severe lung problems; their doctors said their work environment contributed significantly to their disease.

She received nine or so e-mail responses from people who had had headaches and lung problems when they worked with old materials. One had had recurrent pneumonia. Some of them had consulted doctors, who had usually advised them to stay away from old books and paper, but one doctor also gave antibiotics, which worked. Most of the people attributed their trouble to allergies or sick building syndrome. One person has been careful to wear a mask and to avoid the old books when she has a head cold, and has not had any trouble since.

Another person recalled two experiences, the first of which was moving a pile of wood mulch that was actively decomposing and which gave off clouds of water vapor and spores when shifted; and within hours falling ill with violent chills that lasted for days. Since then he has been sensitive to mold and also to organic solvents. The second episode involved working on something with ethanol without a fume hood or respirator, and then for several months experiencing intermittent flashes in his peripheral vision.

Recently there was an e-mail message about a client who had brain seizures while unrolling a moldy rug, and who has never recovered.

Where do We Go From Here?

At a session on safety at a 1984 Society of American Archivists conference, one speaker dealt with Worker's Compensation questions. He advised archivists who became ill or were injured on the job to get it documented promptly with a physician or in the nurse's office. Photographs are useful for this. He said to get a medical report from the appropriate internist, giving the diagnosis, medical findings, and opinion as to cause. Hazards should be understood by the employer, and long and short term effects understood by the worker. Ask questions, he said; it's your health. When hiring on, ask about occupational health and safety, and look over the equipment and facilities. When a problem has been identified, approach management. If that does not resolve the problem, go to federal and state agencies. Go to the union. As a last resort, buy your own equipment or quit.

That advice sounds easier to implement for ordinary hazards than it does for fungal infections. Still, no progress is likely to be made if nothing is documented, and the logical people to gather evidence are probably the people who are most affected by this type of health risk.

In the January 1988 issue of Restauro there is an article in German, "Hygiene in the Workplace: Bacteria and Mold," summarized in the April 1988 Abbey Newsletter on p. 58. It covers mycosis and mycotic infections, with recommendations for preventing infection.

Frank Preusser posted the following reference on the DistList last March:

S.A. Crow, D.G. Ahearn, J.A. Noble, M. Moyenuddin and D.L. Price, "Microbial Ecology of Buildings: Effects of Fungi on Indoor Air Quality," American Environmental Laboratory 2/94, p. 16-18.

James Dast of Madison, Wisconsin, sent in a copy of a page from the August 23, 1915 issue of Every Week (which may have been a Sunday supplement, judging by its size). It is an article about "Women Who Hold Down Unusual Jobs." One of the six women pictured there is Miss Rose Murray, who is

"the only woman in the world who holds the position of physician and surgeon to 'sick' books, [and] has more than 8,000,000 patients under her care. She is the 'doctor' for all the volumes in the New York Free Public Library. There is a very lively element of danger in her position, because books, like people, derive their sickness largely from germs and microbes.

"That is why Miss Murray goes about her work dressed just like a surgeon at an operation. Her equipment consists of a huge apron and a veil of cheesecloth."

Actually, she looks in the picture more like a Halloween spook, because she is enveloped nearly completely in a white gown, with only her eyes, hands and the bottom of her dress showing. But she had the situation sized up correctly, and took appropriate steps to protect herself.