The Ardystil Syndrome Case: when chemicals cross through textile factory, hospital and laboratory
The “Ardystil case” is an occupational intoxication which took place in the Alicante region (Spain) in the early 1990s, in textile factories where they used different paints to spray textile that was later commercialized into curtains, sofa covers and other pieces. The intoxication occurred when they started to use a new airbrushing technique. According to an epidemiological study carried out by Carmen Moya, a total of 257 workers were exposed to the dangers of this spraying technique. As a result of poisoning with plastic paints used for textile airbrushing, 71 people presented respiratory symptoms and 6 people died due to lung failure (Moya et al., 1994). These symptoms came to be known as the Ardystil syndrome (Sole et al., 1996), an interstitial lung disease which results in severe restrictive pulmonary insufficiency. The name ‘Ardystil’ is a combination of the words art and style and was used by the workers themselves to refer to the textile factory internally (Martínez Richart, 2017).
In this text I will describe how the interaction with these chemicals changed according to the different contexts, starting with working process at the textile factory, continuing with the first interactions with Ardystil Syndrome in form of epidemiological studies and ending with toxicological studies that tried to understand the toxicity mechanism of these chemicals.
The working place is the first context of the contact with the chemical substances, where workers directly interacted with toxic products as part of their daily duties at the workplace. The Alcoy region has a long history of textile production. Traditionally, the paints were mixed with water and applied with a sponge, but in the 1990s (Moya et al., 1994) some textile factories opted for an innovative airbrushing technique that would help to speed up the process. The new technique consisted in mixing paints with dissolvent and spraying them with an airbrushing gun. This change in the application technique exposed workers to higher levels of toxicity. In combination with precarious working conditions, absence of safety and lack of prevention measures in form of individual and collective protection from toxic substances, it led to severe intoxications.
To corroborate this with empirical evidence, I carried out an interview with one of the ex-workers of Ardystil (G. Martínez Richart, personal communication, April 2, 2021). The interview was conducted as part of PhD project at Institute López Piñero. Originally it was conducted in Spanish but here I provide translation of the quotes. This is what Gemma Martínez Richart said about the working conditions:
"And what happens about the conditions, in front of us they put painting tables, long tables, very long and there were windows that we opened because there was a lot of fumes from the paint. There were about three or four tables. First there were three. Then they put another one. There were four tables and two workers in each part of the table. Well, imagine two and two, four, five, six, seven, eight, ten. Painting. Well, that was an immense fog, a cloud of paint."
To make matters worse, the workers sprayed this paint on to the textile without any masks or appropriate ventilation, effectively breathing in all the chemicals that were released into the air.
Regarding the way that the paint was mixed, Ms. Martínez Richart added:
“The formulas, it was just we had paint cans, right? Also, they were from Bayer. But if a Bayer bottle empties and you put something else in it, we don't know if it's from Bayer or not. Well, the person in charge is the one who took jars and mixed. Anyone could be the one in charge. To make the orange, well, I don't know, they mixed one with the other and they made mixtures. But I never saw it. I never did the mixes because I don't know how. When the yellow paint was finished. Well, I would ask for the yellow, because there was a person in charge of making the product.”
From the interview with Gemma Martínez Richart I understood that the person in charge had no specific background that would make them understand the actual chemical reaction they were producing by mixing these different paints. They were also unaware of the potential toxicity of the products they were using.
Once workers started to present symptoms, they contacted specialists from the healthcare system. The first symptoms were diagnosed as cold, flu or even tuberculosis. However, the workers were not satisfied with this diagnosis. The interaction with the chemical changed, now instead of chemical were more than just a part of the working process, they became focus of epidemiological studies. By means of popular epidemiology, the workers established a link between their symptoms and their workplace. They started to use homemade masks to see what they were breathing and at the end of the day were horrified with the amount of paint that the white cloth mask would absorb. They also tried to advocate their rights by insisting on improvement of safety measures at the workplace. They asked the owner to install local extractors but by then it was too late.
The number of patients with similar symptoms started to grow and the treatment given to the first workers who presented the symptoms was proven to be inefficient. Thus, the healthcare professionals from primary care decided to contact Public Health authorities who conducted an epidemiological study under the direction of Carmen Moya García, director of public health of the Generalitat Valenciana at the time.
In the context of the epidemiological study, researchers interviewed and carried out tests on workers from several textile factories in Alcoy region. The epidemiological study was published in a very prestigious medical journal- the Lancet- and it was hypothesized that a formula change from Acramin FWR (a polyurea) to Acramin FWN (a polyamideamine) had led to severe pulmonary disease in textile printing sprayers in Spain. The Spanish researchers were convinced that when Acramin FWR was mixed with solvents it would produce Acramin FWN whose elevated toxicity would cause the intoxication (Moya et al., 1994). Remember that to use paints for the airbrushing technique they started to mix them with solvents instead of water. This hypothesis called the attention of toxicology researchers (Clottens et al., 1997; Ould Kadi et al., 1999).
However, the epidemiological studies came in contrast to toxicological studies. The epidemiologist worked with affected patients in the hospital setting and collected the samples of the chemical products used in textile factories. However, their hypothesis was challenged from toxicological points of view. The toxicology experts did not agree with this vision of the toxicity mechanism. They engaged with chemicals in a laboratory setting to design experiments that would reveal the toxic mechanism of these chemicals.
To verify this, the pulmonary toxicity of the components of the paint systems involved was assessed in experimental animals (Clottens et al., 1997). A series of studies were carried out at the Katholieke Universiteit in Leuven (Belgium). According to Dr. Benoit Nemery he was contacted by several researchers from Spain with questions about Ardystil. He got interested in the topic, and together with Peter Hoet (his PhD student), they decided to carry out a series of experiments (Nemery, 2022).
They discovered that Acramin FWR and Acramin FWN both had a very elevated toxicity, thus concluding that the intoxication was not a result of Acramin FWN in as previously thought. Bayer Toxicological Institute contacted the researchers from KU Leuven, and they designed a series of experiment in collaboration. Since the chemicals were directly introduced to the lungs of the animals, they designed an experiment to test the respiratory intoxication on animals by inhalation. Since these paints were safely used since 1960, they were sure that the toxicity of these products was very low and used quite high dosages to demonstrate it. To their surprise they discovered the elevated toxicity of the chemicals and had to stop the experiment for humane reasons, because the intoxication of the animals was very severe. It turns out that the products showed elevated pulmonary toxicity when used as an aerosol.
In the words of two toxicological experts: "The most likely explanation for the cellular toxicity of these polymeric compounds was their polycationic nature (in other words the presence of multiple positive charges on the nitrogen atoms)" (Nemery & Hoet, 2015). However, there are still some uncertainties about the exact mechanism of toxicity in the Ardystil Case.
The Ardystil case shows the problem of prevention when products are released to the market without being tested for pulmonary toxicity. It is precisely the lack of these prevention measures that causes accidents like Ardystil. Moreover, Ardystil is not an isolated case: When the textile factories in Alcoy had to close, the products were sold to textile factories in Algeria, where the same technique was used, and the same intoxications occurred (Ould Kadi, et al., 1994; Ould Kadi et al., 1999). Later in court Bayer justified themselves by saying that the products were not designed to be used as aerosols (Audiencia Provincial). However, if the product had been tested for pulmonary toxicity beforehand, they wouldn´t have needed to return to the laboratories to be tested again.
In conclusion, the Ardystil Case is a case of intoxication with textile pigments containing polymeric amines and reveals different types of interactions with the substance. We can see how these interactions occur in different settings such as: textile factory, hospital, laboratory - each of them with its own rules of sociability, admission, and exclusion. Ardystil Case illustrated how human interactions with chemicals and toxicity are highly context dependent. Different authorized and silenced voices, testing standards, visual and material culture. However, despite the differences, cases like Ardystil force a circulation of knowledge, practices, values, objects, people, and risks between these three spaces which creates a polychrome and multifactorial scenario.
Sofiya Kamalova is a PhD student in historical and social studies of science, medicine, and scientific communication at the López Piñero Inter-University Institute (University Alicante - University Miguel Hernández - University of Valencia).
Audiencia Provincial, No. 29/02, Procedimiento abreviado No61/97, Alcoy-tres: Imprudencia temeraria, lesiones y contra la salud pública, Alicante.
Clottens, F. L., Verbeken, E. K., Demedts, M., & Nemery, B. (1997). Pulmonary toxicity of components of textile paint linked to the Ardystil syndrome: Intratracheal administration in hamsters. Occupational and Environmental Medicine, 54(6), 376–387. https://doi.org/10.1136/oem.54.6.376
Martínez Richart, G. (2017). Veinticinco años despues: Caso Ardystil. EdítaloContigo.
Moya, C., Newman Taylor, A. J., & Antó, J. M. (1994). Outbreak of organising pneumonia in textile printing sprayers. The Lancet, 344(8921), 498–502. https://doi.org/10.1016/S0140-6736(94)91896-1
Nemery, B., & Hoet, P. H. (2015). Humidifier Disinfectant–associated Interstitial Lung Disease and the Ardystil Syndrome. American Journal of Respiratory and Critical Care Medicine, 191(1), 116–117. https://doi.org/10.1164/rccm.201409-1726LE
Ould Kadi, F., Abdesslam, T., & Nemery, B. (1999). Five-year follow-up of Algerian victims of the “Ardystil syndrome.” European Respiratory Journal, 13(4), 940. https://doi.org/10.1034/j.1399-3003.1999.13d41.x
Ould Kadi, F., Mohammed-Brahim, B., Fyad, A., & Nemery, B. (1994). Outbreak of pulmonary disease in textile dye sprayers in Algeria. The Lancet, 344(8927), 962–963. https://doi.org/10.1016/S0140-6736(94)92324-8
Sole, A., Cordero, P. J., Morales, P., Martinez, M. E., Vera, F., & Moya, C. (1996). Epidemic outbreak of interstitial lung disease in aerographics textile workers--the “Ardystil syndrome”: A first year follow up. Thorax, 51(1), 94–95. https://doi.org/10.1136/thx.51.1.94
Martínez Richart, G. (2021, April 2). Interview with Gemma Martínez Richart (S. Kamalova, Interviewer) [Audio Recording].
Nemery, B. (2022, May 13). Interview with Benoit Nemery de Bellevaux (S. Kamalova, Interviewer) [Audio Recording].