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Case Study

A mother who attributes her daughter’s congenital heart defect to air pollution

Your practice is located in a valley with a number of computer-related, high-technology, “smokeless” industries. One of your patients, a young mother whose 8-month-old daughter was born with a congenital heart defect, comes to your office to discuss a recent newspaper article that suggests toxic chemicals may cause birth defects. After reading the article, she discovered that two of her neighbors had miscarriages shortly before her daughter’s birth, two neighbors had recently given birth to babies who have defects, and one neighbor had a stillbirth. Many of the neighbors spoke of often smelling a sweet, solvent-like odor in the outdoor air.

Your patient is determined to confirm her suspicion that a chemical in the air from the local computer chip manufacturing plant is responsible for these events. She has called the city council and is not satisfied that she will get a prompt hearing. She has organized a small group of concerned citizens. She asks you to be a consultant to the group and provide medical information at the group’s first meeting.

Your patient gives you a list of chemicals that she has determined are or have been used at the plant. The list includes arsine, phosphine, trichloroethylene, 1,1,1-trichloroethane, tetrachloroethylene, epoxy resins and curing agents, hydrofluoric acid, and gallium arsenide. You know that arsine, phosphine, and hydrofluoric acid are quite toxic and used in relatively small quantities in the electronics industry. Emissions are unlikely to escape the plant daily. In addition, the odors of these chemicals do not fit the patient’s description. The epoxy resins and gallium arsenide are not volatile substances and are not likely to be detected outside the plant. You conclude that the chemicals most likely to be emitted in large quantities are the solvents.

You contact the regional office of the Environmental Protection Agency (EPA) for information on processes used by computer chip manufacturers and the quantities of solvents that might be involved. The environmental specialist searches the Toxic Chemical Release Inventory (TRI) database and informs you that the plant in question is a major emitter of 1,1,1-trichloroethane (TCA); last year, it emitted more than 100,000 pounds of the chemical. The specialist informs you that the plant does not emit significant quantities of the other chemicals on your list. You focus on the cluster of cases and the TCA exposure.

(a) What are the major health effects caused by 1,1,1-trichloroethane?

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(b) Is 1,1,1-trichloroethane likely to be responsible for the congenital heart defect of your patient’s daughter?

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(c) What is the Toxic Chemical Release Inventory database that was used by the specialist?

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(d) What sources will you use to prepare for the community group meeting? What will you advise?

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Answers to the Pretest questions are on page 15.



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