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July 18, 1966

Epidemic Nosebleeds in Apple Packers

JAMA. 1966;197(3):165-168. doi:10.1001/jama.1966.03110030059025

A new disease of apple packers appeared in 1964 in Washington. Blood in nasal discharges ranged from mild staining to dripping hemorrhage. The disease followed chemical changes in the fabrication of two brands of blue-dyed apple-packing trays made from salvaged newspaper. A third tray made of plastic and a fourth of virgin wood pulp produced no such signs of nasal irritation. Attack rates of hemoglobin in nasal discharges in the control general population was about 25% during the same six-week period. All packers dripped blood from the nose in some plants. Nosebleeds decreased where newsprint trays were stopped. Bleeding began in packers switched late in the season from nonirritating to newsprint trays.