Document 0JQYaO2pvJQ4K00yx1GjO189b

FILE NAME: Metropolitan Life (ML) DATE: DOC#: ML DOCUMENT DESCRIPTION:ZDtZ ..... 4 'AC~""''/' or ... IOICUU. OHICI[ 0' TI1I ()&A". M'? GILL UNIVERSITY, ~~~ MONTR'''''. J1HUU\T .1t.a'~"D'b 1 , 2 , .lUI"'rlu. a. In Iq M.D. edical Dirto r WtirOpOlitaD Lile lnaurauo' CO " J' J 0 a CIT t.- tlr Dr, lnilht, I ba jgn r.t\lnl~ fro. e&lUornia, pd t!Del Jour 1004 In.ter of Janual')' 1tb a..!iu, ... It. ft. Ntr.....l' 1004 of JOu to 'Wl"it. . . . .\M1A !lio. DOt." a~ 1 quU, u .....ta1l4 \tour , ..S:U.... W, an Mre tbu 4.l.lcbhcl at tb. ".'rod.tr .t "be "'1"4 .t 111"0'on ia _,,",r1&t:l&, tJa. M'" lor o~ '''"'7 ....4 yUl 1k tonrar4 ,,1')1 1f"M1' '4-1 .t .0 lIlhnd hlGb work a. w, 01.. oar.., tri. I bop'i,i wID bt t_ ....nt .t ey,....... aid .ore pl._-.mt relat10.. lin.... tbe C._elSa ...4loa 1 .erk tbe 1Iri",oU.~ W. luurur:e 0.....,. "but. W1t~ ",.rt ...4 .ith tor tht .., tflllU' aD4 rturN tor .,. . .""r, .... .,..,...,., .. -.-- ,'" .:;:-:,........ . ..:.'.' JOur ki.a4Ma.....'..- 1......-. . 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N ... ____ WrrM Mw41U_ &HI..... 1rJ tat v,UN). "_'"'*1.6__ Di..... t , ... I ,,-m. I .......... ~, ,.. . , ~ ...... "-ri ..... ,Ida Uftucll ~ 1~'" ~t. ... fneid.Mlt ..,..i.e .. IU' Jf'Uaafr ~. '*" t. """MI........ll uu ....'I'iIw ..... ....au. ,. ~ ". lJ,ik 'i"4Mi ,.neMl. r .,.. :tt. 1M ... tru.Uac tlIQ 'hi" ,... wIlJ. .... t .............. ,.. ....... Ala _ I ... .u,. ..,., """. r ,.1 . ,, ..... .' If' .'!" .. , It, 1e 1NG"W4 that. ". appro&oh 'tot. ~ or ~ r.c\ll\l of l6t4.1olDl of Il00111 On.lYorlU1 wlth propo.al t.be,t, upcm t.be tabll.a.at. or all .4.q\Ilt.e 1parlaent. ot lDduat.r1al B;r,leu 1a the llco1l1 Wedlc&l School the IUtropol1t..e.n ..rt.6r iDt.o au "If~ dt.h 1011111 to a6curo tOr t.he OQapal11 o.rt.a1u ""leu an4 lntoJ'fllat,loq no- bt,1ng to the hsalth or lnduat.rle.l .-onere. 1a Caaa.da. Wlth thl .tteb11'~Dt ot CnnadlaQ a~ ~rt1c. an4 the erundoD or the COtapanr' I ~perat1Oll.1 14 t.h6 Dotdn1oa 1t Nco.. lncr...e~ll 12port.&llt. that t.~ COmpI.rv' ban aocun.. ... k:Qow1e1ip ot condit..l.oDJf ......AIl1tC 1Ddu.tr1al acthit)' iJl Camda. It 11, turt.ha1", ~.t dlr.bl. t~t. the com~. program tor tl_ betterment of the boalt.h or lDduat.rla1 aorkera and thdr h~lHu be f\dY1!lnced in Canada wbl!lre lnd.uat.r1Al h1,1.~ ~... ~hu. of' public heelth .orit 18 aot.o.bl1 ba.clcward. IpMlt10 It would be ot vee.t .....1ue to the ~ to b..,. 1utoraUon r.ga.r-4~ tuCh at.t........ , or 1. ~ d~rlbution todU2trtal eetabl1.k.~. ..a a1DN 1~1'iD& opt,,\1... wlth ~t.. . . .,.. 1Dc \be .....1" or tapl."... 1A . . . Ht.abUm .. w 41rir'iAR. 2. st.u&.... of bt.Mr4ouI pro....... ,. SWiM or .....1d1t.r IoD4 .:wtallV 1n re1*\_ W ~ _lor ladllftrial ptU't'a1ta. . . 1'I\uIll. . ot .neat, Qd tlIt.n.ctW of' _10.1 IItJi"ooo 1.. *1'd.1abJ.. ill the '1IIW~ tnrl.\0t7' ....... in ~ ~ t.he , ...t tiD!. aDd ll1lber1. ope,..tlooM. ~. 0\' .t.I.- ~ ."....t..s.u.. for e4\aa.. UOa&l 10ft " t.M ca IT ..- ':''1".0) o() c.. ( .I (;1 r.' ( ~ ... ~. ".q p""" .--M11 ut_ !au. to MO __ ~ts.. dt.rwtlr W(IIIal4 ~ 41fflw1\ IU 11 It 0CNLl be o~ tro. t.pubnt ot't.- ~ ~ .... OIt.m&at , iliad Uldft,,*ltJ b ~ IDr a . ,.... ... .....1 ..... .,...., ~ '*-tlt... It t.bt eo....., ~ lMS'.n1',U, ,.~ 1\, .. wWa U. UatfeTdtJ it. ....~ Sa t.hI t1e1 .r publl0 MlUt ~ bften\ ftItIld .. lItUl ....... '. It. 1I'Ml4 'IIIIIIIU\ ~ dMNftM "- \be ~'I ~hlb_." pollcq- et .Ubl ,. . " . ,ou1bJA Ouailaa .,.,.....1 W 0'PH'at.1Dc ~ o..zN1&n~... n . . u ~1!1& t.lw O--..v . . ita uUdtJ.M !..Q OOIlt&o-\ wl\b . . h~ll btluewf,1al1Qdl,ltl.b _ ~ PQ'II" f .u.r.. fbouch 18pl .~1.. -: l.a t.bI ..,. tit a eoat.rtll- ut.1.cm 1I;r t.bI Oem....,. too u "~1.1. .1 lrloIItS.WUoa ~ are DIK ~ M wlt.b \he ,laD prcpo.... Ilh .. plu tmtl..... Mt'W~ qvU ' " ._. ~ '1*01.t1.ot.llJ OODllt.1OaH,UfIOA" o...............wna, U. ..... f1"-OJ ot wU. r.ttJr'll to '- ~ 'v' ~ ~ ... ~ t.o - - be -.:J ltpw \bit ",ltl.. ~~ ." .. _,~. ~1....... IPIH~ rrI0396 ... .... . .~ .... , . I ~.:., u.a IboQl4 \bt propoal be . . . ~ t.bI ~ to u. Urd,.... ,..U" be in our p.rUd.p-.\1oa. would 1\, ett-crt. tapOrl 0t.nI41.U ~ ....11 .we "at-.b1. lIIdUllt..r1a1 orp.nl_t.l00. tt.~"'"' than 1\ wouU . N " " tuClL J*,rt.hlS-t.1Cld t.o be lol1olt.e4... ntegw.,ria o.nd t.hI ~ 10 Un!.Wlit7 thtJ ...iNf JMl"I. )~ ... or It b aocordi.=II1, r~t4 thlt .Uh propor 11181 1A 1,be entut. t.he MttU.nt ot tuU.bIo oond.lt.t.ou GonaldentloD or ~et"iQ ..nlo rend,ted JIa.J to l&o01l1 aut ot fin t.~ dollar." ~11 cS~ ptr104 ot , -I \i.i . . t f . ,. ~~ . . " .. "'1.- If' , , C39? ('. ) - . "... L. .~ t.. i"o' f: ," ' .. or I do ~ kilo. wbe1.bN- ar DOt. t,ho PI"Hldcratb etlll ln~ere.~ed in tabl.ih1~ ~ ~rt relation .1~ MoOl11 or 1IIOt. 3e1t,ber OM I r.nll Juat . n t.ho Ot-toawa ~or.aer-.torw leJ'''' 1~ take. place b\.n. 1t t.hIlt eOAt. ia tUll 1n 'Ute oftln(: u..~.'Nl .,. ;r..D.I! U. to do \he p-ac.ehl _rHl armo~ oW' propoHd. relat.10D1 wlthet.be Un1~1\f. ';l1.h1A t.ho pt..to. \.0 WHk.a or ao th,re hi.... ~ .,or, or t-o 1ape!"t.ut Ud ""1Oftt, Oolll. tor l.alp fr03l C&l'\tldiAQ tlr=-.. Oot la t.M . .to .01.1.... .r t,bIt k1& ,..,., 604p' o lH. f'I'CMI t.b&t ,~pol. et t.bor NaUona an4 . . or t.t. 1..,.,.,-t.. the)' ar. nDdlt ~ - ... ~h. I"Ml'J;la'Auao ot 1.b&1r _mI. _41od FOCI'- wl\l:L ,..lM1o um.l ....IM.1.a, ..t, t.bD rKOt1nGMatloll t.ht ~ ...1~. fhl8 b t.blt s,.n1M fU..n Pulp ar1 I'.uor C01IJ$G1- tbo .t.Mr ftl.r1\ 1. ,,-ltrt.i.o& "lM\ ...,. ~Qt.rfJal whIch .to. It.unehl.: "lld ...... to. ~ nertbodr 10 ~lr Mlplrq ..w al.. t..be ~.Z'1t .,t u. tuUs. or ollPl~... htJl tho.. 11'0"'1"1 QD~ ct,. . . .toh1~ tLn.t le\ et M1,. .on It, u w!L1c.h .. CIU .t. ecll _11th &U.rrto~1\t ~ tt"t. l!:p.... .... i "MUl... ....t _)doll O'...iM c.wl... t..t.tM ~ Oa.-.h .. J.~ ~ .r ...... \be .......,lUH 11.....-- \riI.l 1V"pe~ at. 100111 .*U M ....1. t.. ,...., ..... ftla\1e ..,.1-. ,_I"oa.r,. It ' " \.Jit.1* ..U ttt 1IItQt,1~ tM.. _t,tMt Mr. ,.".,. ...:L. 1.. ,.. all M\al.1..k Mt 1~ know I 111d DDt , .. . \bt _\1M .t tM . ' . nldl_ wri.Ul ~111 w1t.h Mr. Snen, let.'lD& ~ 1. ~SJt ' " ' . . . " _ DB .... ft'ltb'. TIa1t be..... It ".. wLA 'too fW'\bar ~Uora tr-Irp ~nt .-1-- t.11 Ida ., \bI i.bI U. .r Dr. 1I.rU.o' . "i-it. tor bit mo.. ~ et u. ".' "THE THING I WANT YOU TO TAKE HOME AND THINK ABOUT" Business Session of the Managers' Annual Convention, January 29, 1925 HALEY FISKE, President My dear friends, I have left for mvself but a verv few minutes to ~ay something to you at the conclusion of this exhihit of the year's business. I don't like merely to read this record and dismiss you. I won't see yam again to he able to talk to YOII for another year, except as I hope to be able to meet many of you in the Field during the current year. (Applause.) I don't count Saturday night. because in making way for other speeches, I cut my own down to the shortest possible limit, and what I shall have to say there will not be directed entirely to you, but also to the listeners-in. who. this year. will be millions and millions of people. I understand that we have engaged all the systems for a certain length of time, and that everybody who has any Idnd of a radio at all. will be under the necessity of hearing inC speak and have the delight of hearing the other speakers. I like to confine my remarks sometimes to a text. I don't know but that before I get through today I may preach a sermon. I am very much stirred up. The Reverend Father BULL is one of the most dis- tinguished men" in England. He is a member of the Community of the Resurrection. That Communitv consists of learned men whose occupation is writing books and preaching sermons and also doing mission work. Father BULL is known all over the world. One of the vows of the Community, as in other -religious orders. is poverty. When a man enters a religious order. he has a vow not only of chastity, of obedience, but of poverty. All that he has is surrendered. and thereafter he lives the Community life. Father B /Ill's Vi.rit to HOllie 0 fjice Father BULL was in this country delivering a course of lectures a\ the General Theological Seminary. He became mllch beloved. I was privileged" to meet him. He came to the Home Office. Later. he had a conversation with my daughter which was rather illuminating. With that notion of poverty and that idea that this material life of ours is temporary and that eternal. life is the only thing worth considering, he said he never liked to meet or know rich men or the officers of rich corporations. You can see his idea. He was good enough to add to my daughter that he m,de an exception in my case. And why? It was no merit of mine; He came here to the Home Office. He lunched. Then we showed him around. I thought he would never get through. He said he thought he had walked ten 439 ;~~~~: ,', '.~". 0" ~': 4. ,'. -!-!~'i! : ....... f~' i- .04".. -4' ~;~;... ~;il- ...;.. ~; . .;:. ::~~;" .::~ . )":, . :.,. ,'''0. :. .r .. .}~"~..=.. ", 440 MANAGERS' ANNUAL BANQUET, 192.1 miles. Then he wrote me a note saying: "1 thoroughly enjoyed my "isit to you and what I saw of your wonderful work. The vast astronomical millions made me giddy. I really believe Goo is training some of you men of big business for use in His Kingdom, as a union of the human race in a cooperative commonwealth of nations beneath twhheoFhaathbeitruhaolloyd tohfinkGoion wmhililciho:n-iss."clearly His will, and He needs men CooperatimJ Our Missioll Cooperation, making ourselves instruments of good, carrying out Ihe will of Goo for the betterment of humanity-is that or is it not our miRRion? That is the thing I want to say a word or two about, and that is the thing I want you to take home and think about. The thing is put upon us, not merely as a life insurance company, but as a life insurance company which has one-fifth of the population of the country insured, whose system involves weekly visits of agents, \\'ho make .100,000,000 or more calls a year in the homes of people who need help. That is the situation. It develops at once Oppor- tunity, and I say that as men belonging to a great corporation and ernsgaaygethdatinhuamgarneabteipnugbsl,i<s;ucwhoarks, yiotupauntsd upon' your us Responsibility, and agents are, can't afford tthoogseet oipnptoortthuinsitdieasil.y r(eAlaptipolnaushsiep.)with other human beings and neglect I am taking it for granted that I am addressing a body of men (and through them the agents of this Company whom I love) ,who are not mere agents of an insurance company, but human beings. They have Goo's life-blood in them. They have, as human beings, human relationships, and this Company creates for them an abounding human relationship. It puts them into weekly contact with millions and millions of people, and I say that no man who has the fear of Goo and the love of humanity in his veins can possibly meet those oppor- tunities in the mere relationship of premium collections and death claims. It isn't possible, it seemR to me, for a human being with a human heart to go around and make these visits and not do all the good he can, not contenting himsel f with simply keeping the, contracts which the Company has made for him. The H o1lle Office F IIY/1ishes the Means Now. if that be so, what can we do? What we have been doing at the Home Office is to furnish you the plan and the material by which you is nursing, can meet those Goo-given opportunities. and I have talked to rou about that so First, often of course, that I am not going to, talk about it today, except to say that I can not understand at all the act of an agent in neglecting any sick Industrial policy- holder who needs a nurse. Then, I am talking about literature year after year, and I don't wa9t. to say much abo~t that. But, gentl~men, if you.yourselves read the hterature that we Issue, you must be Impressed WIth the fac.t that it is very, very instructive and helpful. I am persuaded that It has I; ~ ! ADDRess BY HALBY FISKB 441 ~1 ) I .' been largely circulated where it would do the most good. I do hope that you will continue to see that it is distributed where it will do the most good and in the 11lamlor in which it will do the most good. And the mallner il, which it will do the most good is by consultation over the pieces of Iitl'rllture hetween the agent and the family. For thirty years I have been preaching that this Company of ours is a family. I am rejoiced now to think, at the end of a generation, . that everybody feels it to be a family. After all, we are members of a great human family. and it is that feeling of a human relationship ,', which 1 want men to cultivate. It is curious how the heart-touch of human sympathy will enter into men's breasts on the slightest occasion. ~ 1 was reading the other day. a letter from one of our districts. It was a story to me extraordinary which illustrates the feeling of how yearning people are. how aching people are to have human friend- ship and sympathy. One of our men called with an assistant or another .> agent at a house which he understood was uninsured. He knocked at the door. The door was slightly opened and then a bar thrust across, and the man said: "\\'hat do YOU want?" "I want to present to you the subject of insurance." "1 don't want to hear YOll. I have considered it. and I won't take any, and 1 don't believe in it. and you can go away." He said: "Welt. I think I might say something to you that would be interesting at least to your family and yourself. if you wouldn't i mind letting me in for a few minutes." ,~. The man's face softened. and he said, "Well, come in." The agent opened the subject of insuring the father and the mother and the chil- dren, and he made no headway. The man got up in a kind of disgust, left the room and went out into the kitchen to shave. Of course, the agent kept on talking to the wife. The Christmas Messa(}c She hadn't any power to sign an application. but on a chance the agent said:, "I wonder if you would like to listen to a Christmas address made by the PRESIDENT of my Company to the men and policyholders; because if you would, it happens that I have a disc in my car outside and a little phonograph, and 1 can put it on and let you hear it." Well of course curiosity got the b~tter of the woman, and she said: "Bring it in." He put on the disc and repeated that Christmas message of a year or two ago. which went all over the country to agents and to policyholders. There was a listener-in f rom the kitchen. He finally burst into the room and said: "I missed part of that. Do it over again." It was done over again. and the agent left with the application of father and mother and every one of the children. (Applause.) Of course. you know that story isn't told for the purpose of any exaltation of myself. It is done for the illustration of what I am insisting is true: that the hearts of working. people are yearning for sympathy and human relationship; and as soon as that man found : ' .~ 442 MANAGERS' ANNUAL BANQUET, 1925 that the while to agent belonged deliver to him to a corporation whose head thought a Christmas message, he said it wort a member of the corporation whose the welfare of all his policyholders President thinks of whom I am : "I want to at Christmas b a Do you see t Can you get that argument, that goir.;; to he one. feeling, that impulse tha was in people, wthehemthaenr 'sthemyinadd?mitTihtaot rfeneolti.ng is hi the minds of all workin! . Tho Mea"i,l!] Reaches alld Toucltes Me" Who Work Now, reaching Group out to Insurance, even more than Industrial those men in this matter of human Insurance, relatio i: heca-use The it involves a cooperation between system of Group Insurance is one the employer whic and nships employe mlltual contributions, ties up in a business h, in effect, ties up ih sense. the employer ana oltIhwheinpeemrinshplbomyeli,naesnsd. tainesd ththeemy uapreinina pfaamrtinlyersshenipse.in Tthhaety saernesein opfartjnoeinrt- hinding ip, that mutuality which together of millions of is the glory of the people for mutual Metropolitan, support, the that heautiful thing in the world. I tlte employe that he and his boss t is are the consCiousness as one in this on the most part of -that is the great benefit that is produced by Metropolitan family Group Insurance. It iCdnoagepsiittaaltmoaenyldoiouLrraatabetotera,nnttdihoenisemsplIlroeyetor aanmd eelmiopraloteyet.heThreelraetifoonresh, iIpsambebtwrienegn- ness which small exte we are because I feel that doing, doing to such a this Group Insurance busilarge extent, but to such a bvealuenaJb{laeJ{tehdnintingastshfarcotommis paianprteuedhreliswcteipdthoaintthtaeollfpivoniseslwiibfeiwliithnieiscsuh.raiasnncyeo.nceorpoof rathtieonmcoasnt l"pl/('1Ice of tllo MetrOfJolita" in Li1lking Employers a1ld E",plo}'cs ill Bonda of Mutual Interost I said to the something about Veterans the great last night, power of and this I think I said to corporation, its you last great year, \vealth, the great responsibilities that come and the great mass of dangers that tcwioehmdiceht.ogheaBsthunet,rotgineonntGllyermothueepn,wIwnoshrukoriancngacnme?ewnitihnsstuarnedd,thbeutaettmitpuldoeye1r)anadCeommpplaonyye try all members of the come to any compan Fancy the Metropolitan. Fancy industries of this the power that counwould any this company coun that y. has othne itdsefbeonoskes aggraeiantstmaassssaeusltofthathtewpooupldulactoiomne to of their emptlroyv. emrsa. sseWs hofenpeyoopule taelnkgaogfedGirnouinpduInstsruyrainncecooinpetrhaetioMn with mpoolnitlavn,knYoOwlina. reGnroout ptaIlnksinugranocfe.GarsouitpisIncsoumramnocnelyatknaollw, as it is etrocom- of wimt and the you may parment call wholesale life insurance, of death claims and the pay the n, is a system payment of prem.iitms and dismemberment Ivletropolitan Group. and sickness Metropolita claims ment, perhaps, of aCCIdent and all that. That isn't politan Group Insurance is n Group Insurance is nursing.' Metrodistribution of literature. Metropolitan _.. ...-._---- .... I . f ADDRESS Dl' HALEY I~I!>"li 4-lJ Group Insurance is the study of hygiene of the worker. Did you hear me read that list of forty different things that Dr. WADE WRIGHT is doing in his division? Can YOll see that he is reaching down into all the hazards of employment ; that his purpose is to bring' home to the employer his responsibility for the health, the welfare. the lives of his employes? Can yott fancy this Metropolitan entering into all the employments of this country and going down to the working man through the employer. or independent of the employer. and looking after his health, his domestic conditions, his methods of carrying on his employment, the things provided for him in the place ofemp10yment. And this hygienic investigation and survey of Dr. WRIGnT is to go down into the homes of the working people and see what they are at home, what can be done there in the domestic way to advance their welfare and health. Do you see now this human relationship exten?ed to the 11th degree, this l\Ietropolitan center stretching out its tentacles in every possible direction to reach the domestic and the working condition!; of working people? And then do you see that it is the sweetest of all things, the tender human relationships, the heart touch of crowds who will say, as you go on in this work, that you are marked men in the communities in which you live? The working people will look up to YOII as their friend and their advisor. Employers will be seeking you to know what more they can do. Capital and labor will lose their strife, and. as Goo's people under the one roof, whether they be capitalists or laboring men, they may be brothers, and you and your agents,' as YOll walk, will walk, in and out as brothers to humanity, as friends of every man and as servants of Goo. (Long applause and cheers.) COPTl' ~. -- " RllOR" or TBI ACTIVIT liS OJ TBI IIDUSTRI~L OLIIIO, MONTRE~1 GENERAL BOSPIT1L, lOB THE tBlB SIPTEKBIR 1, 1928, to 1UGUS! 31,1929. CLINICAL .<';, Out (AI The lnves~1gation ot occupatl~nal ratiente ot the Hospital has progres.ed d1s.a among the this year in the same manner a. the previous vestigation doe. not appear year. to be The number increa.ing, ot ca.e. tor inand I am of the opinio learch n'that Itand this point , a lp il e ct le o s. t i the mpo .ork rtant , t whi han l e va .ome l ua ot ble the t rom. other r~-\ I ~ activiti at the to the Industrial Clinic. ~~ctual11 Clinic during the there re 523 period. Among casal tha.e retarr'ed /' .ep----.' - . 30 cases ot poisoning. active Lead Three c Poi.oning, 3 cales ot carbon monozide of chronic ars.~ic pol.oning r e.n '\ ' in the Hospital .ards, but th.se were not Industri.l ca , .' ;'/ .. ' (B) The ezamin.tion HOlp1tal tor certit1cate. hoat l Job0e4.aRcaonndtlienrsu.dre. terr~ecdtuatol11th.t.h.i.' .. ,": have been 275 of the xamin.d. <,~~:~i.~' '~". (0) 383 Indu.trial acc14.nt ca r. qu tlon.' .~~...::a.::~~:,:,;:,;.:.. r.g pro .rd c t o o f t he 00 ca .pl u 1at tloll ion, . a n d Th. ca flg nnot ure b. . for glv. th n. l 1 It 'h. ud1 d1f f a 1 r. cu 11l-:"1l . lt1.1 . " of al tud1 .oon a. ot 1t this tlpe fro. 18 undertaken, ho.p1tal record. b.coppar.nt for on. h 110 a ur.ae. th.t all accident c of given coapall1 com. to the Ho.pital for treat- ment. .,. rIILl) ACTIVITIIS. PRODUCED S/GrMtM (AI The Pl.nt Me410.l Dep.rt.entl .hlch r tablieh.d 1n the fir.t lear 01 t op.r.tloll of tl.faotorl11, and h.v. h.n41.4 a thl1 Cll1l1a have oontlnu.4 trlltou. yol of work. In' the l' 1 1111 Jh1lio.l .xa.lnatioa. hav. be.a p.rfort, r tl ,lY'Il, e'l~ 11ota tr.at..at. aa' '4' " Itat11tloal Itat'.'lltl 01111 4 arlb. the D.pa.lrtpaIrlt'.oltJlthpeal"v'..rl0I .''b.pl1l..v... .than.ra.g.1r1l ill oa th Kedloal Dlparttl. ~ Ilb.~ of firm. h.ve ba but 'on11 2 havi gard donf"o. to the formatloll Both th firm. of Medla.l Departm.nt., have .ng.g.' ph1. t 1an. reoomnd.d hl the Ildultri.L Clln1c, .nd gener.l line. reoo...nd.4 b1 the 01inl0. are op"atillg alollg Durin, ~h. 11.r on. the large .teel comp.n1 in charge. .stablishl' a Health S.~Yio. with a The Indultrial Clinic .a. oOIlIGlt., full ti ill r.ga~d ph711cian to the org.nization we.k. during of thil, and aotuai17 oonduotl' the rvie. for siz ~h. ab.ene. ot thl ph181alan oa'a'GO&A~ ot .1okn Anothir large pl.nt Servic., stimul.ted manufaoturlng aompaD.1 tabli.h.d 1 believ. ~1 thi. Clinic, but the a B.al~h Clinic wa. not cons~lt.d to it, organilation. - 2- (!t tha' 14a~ .t co-operat1Te HealthS.rcla to al1 plante, .hloh wa~ .pon.ore' b1 the Canadian Manutacturer. A ociation, ha. m.... no,.. progre thi. ye.r. (0) Th.r. h.T. bean .eTeral call. tor inTe.tigation ot pl.nt conditions. A tairly extenliTe .tud, .as made in one bron.e toundry. ~ number ot .ir an.l,.e. tor lead re carried through. The r.lults of thel~'ltudies torm the ba.t, ot a paper \0 be read at the annual meeting ot the American Pub11c Health ASlociation this tall. A study ot the carbon monoxide ha.ard in a large garage wa. commenced lalt winter, but wa. dilcontinued tor lack ot apparatul. The purchale or suitable apparatul il contempl.ted and it i. hoped to continue this ,tud1 during' the coming ye.r. ~DU-:ATI01U,L. (.) Lectures in Industrial Hygiene haTe been ~iTen \. the. third year studentl, the studentl in architecture, the ScheOl ot7 Graduate Nurle., the School or ~ocial Work and the pupil n~~.el. . _ or the Uontreal General HOlp1 tal...:,:,;~:.,,~,:~::.~~'~'~'.:'~ '(B) giTen to. .1 special the Public cour He.lth ot Bur 12 , l e i o n t ur the with Sohool t i.l ot d G . Ti.l\.....4;.~:: -.<,.. r . d u. . . . .:. . .t~..:..:: (0) 6 ?opul.r laoture. haT. been dalIT.red. .t Tarlou. olub. and looietie. in ~ontre.l, and one in Toronto. A:ISCELL.llNIOUS. PRODUCED S-.'CINVMs (A) An Indu.trlal Dent.l Clinio .a. open.' in Deo.mber 1928. The Clinie i It-.upporting .0 tar running expen.e. are con- c.rned, but the Bo.pit.l donate. the u ot the .pao. wlthou\ charg. tor r.nt, light, ht and laundrr. At thi. Clinic 182 0 haTa been treat.d. Thar. ha. been. total ot 185 treatm.nt. giTen. In the organilation 01 thl. Clinla two fir don.ted .360.00 to purcha.a tha n.ca tar1 a,\llpm.nt. A total of ~17aO.46 hal bn re~. tri.l Dant.l Clinio, of whloh tha IU. ot tl tor ,alarl and .uplla., la.Ting bal.nca ot. .eknowl.dga h.ra wit~ th.nk, tha .,rTie,. ot th.: .1\~~ . who haT' .p,nt their ti., at thi. Clinio , r.nu.,ration, .nd to tha nur.,., who To11liri r tlm. to si.ting the 'Inti,t Of' (B) The .t.ft the Cllnio i.t.d in ~h. produotlon at the periodla Bealth Ex 1na~ion fl1m ot the C.nadian Medic.l A ool.tion. Thll ocoupied ~.r1 oon.ld,r.bl. amount at tim., but con~idere' 11 worth the ~ime .p.at. (OJ Th. lndultrlal Yedlcal A'IOol.~lon ot the ProTino. 01 ~uebeo conducte' luce,sltul lear. A ~nion ot ~he Jrenoh and English .s.ool.tlonl took pl.oe, and thi. united A oclation in collaboration with other organi.ationl .a. able to render con- siderable lerTioe to the 40rkmen'. Compen.atlon Commi ion ot the . - 0459 --... t - 3- .. '. '''~' ...#.,.~.. 1 0 .to". . Pro.,tu.::.t CP";'R in thl Ixten,l"e re.,l,ioZl or their Tarltf. Sl.,.~al Ilnl~.l "Iting. were '114 4~ring thl 1Ia~, and a very luco tul 41 " melting at the annual melting ot the Canadian KaAle.l.. u.ociiti,n. (DJAn .ttort hal been ma~~ to obtain permi ion to 8t~dy the ettect ot a.belto. fib~, on the hlalth ot Two large companil. were approachld in thil regard. one, pOI.ib11 on acco~nt ot tinancial dlfficultie., to spon r such a ,tudJ. The 'Ioond hal decldl4 to an Inve.tigation for It.elf with our alli.tanol and 1s to be hoped that information or Ici,ntltic talu. workerl. '1hl tirl; wa. unw 1l11ng undertake advicl. It will be forth- coming from thl (B) Thl dir.ctor ot the Indultrial Clinio attendld 4 oon.,ention. d~ring the ,ear under re.,i Respectful11 lubmltted, .. ~. (Sigaed) irank G. Pedll7, Th. lndu.trlal Clinic jIO. . . "  --.-t.o. ... copyl or R!POR! 01 TUB lCTivITIES THE INDUSTBIlL CLliIO, ~ONTBXlL GENEBlL HOSPITlL, rOB THE TIll SIPTEllBEB 1, 1929 to .lOGOS! 31, 1930. CLINICAL EXHIBIT . ' ML-Sll\D The clinical york in th. Hoapital a. distinguished trom that done in the tield hal continued al in the pa.t, and an additional dutl hal been aSlumed, namel, the .uperTi.ion of the health ot the BOlpital Implol.... Thi. wa. undertaken a8 a lerTiee to the Hospital, and hal little Talue trom the vniTerlity standpoint. The new aotiTitr call. for an ,xamination of all nlY employees of the Hoapital, and require. that all ca ot 111nell a~ong tbe HOlp!tal emplo,.". b. reported to the In~ dustrlal Cllnic. During the liar 80 pr.-t.plOlm.nt .%a.lna~1on' and 38 perio~io re-examination er. performed. 410 .1ok ! emplole or the Bospital .er ,.n and tollo.td until the,' ~-:. .. termination ot tbeir 111ne8 Tbl. llltera, aa it operat ..l:~ preaent, 11 not enUrelr .ati.taetor,. o'n account of the n...~l' ot ' departmentl whlch engage their o.n p.rlonntl, and a conaid.rablt number of nell' taplo,.e are b.ing tngag.' .Itb no .xamination. en BO.'Ttr, It 1, hoped that aa the Talue of tbi, txaaination be- ~ - com appr.oiated all departaent. _ill takt adT&ntagl ot it. .2 - The studr ot occupational 4i a a.ong the Out-pati.nt. Uo5 of the HOlpital continues. Some rlault. or tbia work art now 53 app.arin. One coac.rn, which .tor.lrll oontributed a large numb.r or oa ot l.ad poiloning to tbil ClInic, hu IItulilbldO a nell' ractorr, partll on acco~\ ot the IIT.re llad halard .hicb :J Ix1.te4 1n tb. oIl plant, and another fir. hal inlta111d a fume 0 remoTal 'l.t.m whieb Ihould reduct tbe balard T.rr conlidlrablr. () g: 22 ca or aotiT' l.ad pol.onin, r. trlate' and InTe.tlgated. r u '1'11'0. ~f~ ~h~,. ot ap.oial intlr t, and baTt b.. n .rithn up ' / # . tor: ',' .,i~ r. por t, .nt in tbt Journal or Indul trial B1g, ,.' or. tbt ~ontreal K,dioo-Chirurgloal llioela- titn~ ~~.t, ng lIal on. ot tht prinoipal dll1all . . . . n, ..,-:a'" a1:t ,', 'w' j~' or occupational 'kln dl all. w.rt In- ....~f{.~~. eonn.otion an arrang.llln\ .a. aad. b.tween "" ..\'ilW.rcnd tb. Skin D.part.ent ot thl. BOlpUal to und.rtake an InT tigation or a 4traa~ill. eau d bl a c.rtaln 1.tion or hil. Thi. inTe.tigation lIa. carrie' through to a Terl l&t11- factory e9nclu,'.1~iPR1~ the Skin D~partment. 1ft., 0454 It ma,. b, .';fit~d bert that the ltgal alplat or occupational dilla . . . 1. l~~~:;l!ir u.naatIlrac\orl oondition in thh ?roTincI, since no pro,Tt~tSn.o--;! lIa41 tor Do.pen.aHon through the l'orkmen'I,Coap.nll&~lq'n,.,J.et. Thi. matter lIa. brought to the attention or the .rrovince o!"'~uebec Sarttr LeaguI, and a com.Hiee lral formed to inTe~tig&te It, but 110 tar, untor~unately.~ommittel h'a hen ury in&ctiTO. .. - 2- Th. Indu.tri&l Dental Clinic hal had & T.r: lati.ractor: :.ar. Itl c111n1ell increaled, andcon qulntl: an increase ot Ita!! wal nlceeearl. 268 new pati.ntl .,r. tr.ated and 984 tr.at~ntl giTen. I belieTe thie Clinic 1. ot r.al Talue to tlie oomm.nit1. Indultrlal work.r. can g.t goqd dental rTlee at a low co.t, and lince the Clinic il 0plrat.d a~ night, they need not 10 time f~om th.ir .ork~ Th. financial Itatu. ot the Induetrlal Dental ClInic 1s latlefactor.r. the feel trom the patiente belng'sut!iclen: to pay the op.rating COlt. FIELD ~CTIVI~IES. The plant ~Idical Departments haT. continuld to earry on their ~ork, And haTe giTen general .atllfaction 10 tar a. can be determined. It 18 our practici to lind to lach plant manager a monthly report cOTerin~ t~. actlTitlee ot his ~edlcal Departm.n~, and indicating tk. It&tl ot heAlth ot hi. employees. Frequlntly suggestions art made &1 to ImproTem.~tl in his plant from the standpoint of health. Th"e luggeltlon. are alway. gladly r.ceiT.d, and usuall: tollow.d. In th.. ~Idical D.partment. 1056 phYlical .xaminl~ionl w.rl ma~ 4_(ln, the P&lt YI&r, 15,605 .urgio&l tr.&tmentl And 6336 .icka'I~' tr.atment rl ~lTen, and 889 nur.Ing Tillt. lude to "hi .:~. '. ot the IlIplo:e ; ":/~~" j ! number or firml h&,e be.n approaohl' in rlgard to e.tabllshing &.dical departmentl, but no .uc hal att.nd.d our ettort. this year. I bllieTI th.r. i. no doubt that the rTie" already .stablished haT. g1Tln .atiltac~lon, but thl ide& hal not sold it.,lt, and.w. haTt had Till te. un.olicited r.quist. for information and adTioe abou~ ~h. organi.ation ot medieu 'llTio,.. I~ 11 pO.liblt that the .n,~al lndu.trial depre ion hal been re.ponllblt tor this. j en Four n~w .otiTltie. wtrl propo.td tU71nl the year: ~ (1) ! atu41 of alb. ItO' wOlklrl. .... '. . .. ":,;:,;,,i-~;k a.'1 ot ~ large group ot worklrl b: X-raT C75 :':~.~:1; "'~ ,.tlrm1n. the incideno. of 1ub,ro1l1o.1I. o ~ : ~~'" .~t ~. . ...t-;~" .. :. .,.:~ . -::~.~ . ~~:;.'.:\ud: of pI:ohologio&l tl.tl for au~o.ob1l1 oLJ "',>. :.',....,,.~;..,...,~,:.:~- .......-,......... . Il'i with the Tit. '\0 dtartalia, ao01dentt. ::J o . o (4) !he organisation ot an Oooupational !hlrapl u: York.hop and an Indu.trlal Yorklho, tor hand- Q ioapp.d 1nd1 Ti:d1t&~~~. ." ~ ... t.1 .!)" (1) !hl a.bl.to \a..~1).1"1. ntarin! ooap1.\1on. 102 lndiTldual. wert Ixaminld el!1-ni~CI'ally I.lld b1 X-ra: at the plant ot th. Canadian John.-ll&nTill-~~O:o. in .l.b toa, P.Q. in Ja.l: 1930. Oth.r group. were Ixamine' at Thetford Kint. in Sep- tember 1930, but the.1 do not come .ithin thl purTil. ot thi. report. This .tud: 18 being carried on .Ith ~he ao-operation .~ ... 0455 , .... - :5 - at the .ttropol1tan Lit, Insurance Co., and It i xp.ct.d that Tal~abll intormation on the lubjlot ot a,b.,to,i. will be fortbooaing. It 1. hoped that permi ion to publi.h the re.ult. w111 b, Obtained. (2) Th. Tuberculo.i. SurTey will probably b, commenced during the co~ing ~ear In co-operation with the Canadian Tubtrcu..loeil Aelociati'on"th. Sun Lite Inlurane. ,Co. and other bodie . Since tuberculosie i. luch an important dise~ee In the ProTince of ~ueb.c, particularly among indu.trial workere, it il tX- pected that re.ult. of real Talue will accrue from thia .tudy. (3) Th. plychological study of automobile driT.r. wa. discus.ed In committee and th.n propo.ld to the In.uranee Caaualt1 Ondlrwriterl Allociation, but the1 did not .how suffici.nt interest to warrant contin,lng the catter. (4) ~be organilation of the Occupational Th.rapT an4 the Indultrial workshopi tor handicapp.d indiTldual. II .1ill mooted, and wil~, it i. boped, be accomplisbl4 in the tutul In that conntotton the Dlreotor of the lndti..trlal Clinllh . lirT" a. Prt.ldtnt ot thl !s.ociatlon ot Oooupatlonal fht.'J1 . and ha. Ti.it.d a number ot work. hop. in oth.r cit1l1 to'~ ~1:v.. ~~'~'.-: aoquaint himBllt with th.ir organl,ation and op.raUon .... ,. . ':. !DOC!TIOI!L. Leoturel haT. be.n giTen at the OnlT.r.1t1 in the 'acultI of ~tdloin., the Sohool of Sooial York, thl Sohool ot Graduat. Jura and the Department ot !rchiteotur S.T.ral a4dr haT. b.ln giT.n to club. and .oci.11 in Kontr.al and .l htr A paper, ~L.ad Poi.oning in Bra and Bronle Indu.tri - rl&d b.torl the Indu.trial BIg11nl S.otlon of tht American Hlalth A ooia~ion at It. Annual Melting in Minn.apo1i, ~~~;;~~~~~.r. "~b. Inoid.nol .t Ocoupatlonal Deafn , ~, PreT.~tlon", wal r.a4 b.forl the ll\b the American ."ocia\ion of Organila~ion. for ng, in I.w York in Jun. 19~O. Through the iroTlnoe of qUlb.o Sat.tI Leagu. and tbl Yontr.al Clunoll ot Soolal Ag.noi r.pr ~ta~lon wal mad. to the ProTineial Dlpartment of Public iork. and Labou7 oa b.halt In ot handloapPld work n who art dilcl'i.ln&tl"~ againl' b1 tbl Torkmen t Comp.nsation Aot. thla oonn.,tloa the Direotor ot the Indultrlal Clinio was a,kl4 to rsad a pap.r b.for. the International !s,oclation ot Indultrlal Aocident. Board and Commi ion. at It, Annual Melting in ~ilaing'on, Del. in Se~t~ 1930. '. , . .:. 0456 . .., - 4- Thl Dlreol0J or the Indu.trial Clinic l.rT.d a. CbairDan or the Indul1rlal and Bconomic Section ot the 2nd Canadian Conter.~oe o~ Social 70rk held in Toronto in Kay 1930. The' Indu.trial ~edlcal '.,ociation ot thl ProTinCI ot Queb.o hal held riTe regular melting. during tbe year. The attendance at the.e reeeting. ha. be.n bet.eln 20 and 35. Thl member' regularly._ttendlng the meetings appear to enjoy them, and 1 belleT8 the organilation ot thl. ~sloeiation hal been .ell .orth .hile. It plan. during the coming year to lend lecturers to dirferent ~arts ot tbe ProTinee and .0 extend the intluence ot the Association more .1dely. Tbe Director ot tbe Industrial Clinlc attended .ix national or international meetings durlng the year al rollows: The Annual ~eeting ot the National Satetl Council, the Annual ~eaiing ot the American Public Bealtb ~1,ociat10n, tht Second Canadian Conference ot Social 70rk, the !merican A ociation ot Organisations tor the Hard ot Hearing and t.o m.etings ot the Conterence Doard ot PhYSicians in Indultry. . 'i l .' .': ~ ~ ' . .0' 0" ~'.. ' . .' ~l ". .,. ..;,i,- . ~!.:~\r~ -.:; - -!- :-;t.:-~:: . In religning thl pOlition of Director of the In4":,"\rlal~~J~~ Clinic 1 .itb to .al that lt il rq beli.t that tb. lndu.trial Clinic Ibould b. oontinutd along tbl lint. alr.ady .Itabli.htd. J.lthougb numerically the number ot ca.e n and tr.ated 11 not larg., the looation ot tht Clinio and It. aotiTl1i haTe .erTed tbe uletul purpol' ot gaining contaot .ltb Industry, and It - .eeml likely that a. ~im. go on the f1.1d of u tuln ot tle Clinic .ill be .nlarged. CJ) ~ ~ It was ~ hope at tirlt that mort UI' could b. mad. ot () tb. olinioal aa1.~1.l pal.ing throu,h ~h. CompeB.a~lon Clinio, () but so tar no m.thod hal been tound to bandl. ~hl aterial in C~ a u !ul .a7. '.~udy wal carried on lal~ 1'~~ of the acoident iJ ot ~er.l l a r , . t i r , \~t linoe tbt firm. did no\ lend(J 1he CllB10 a pro).r 1~.t1.\ioal baokground ~ o min.d and ~ht r ult of tb. Itud7 re ot nO CJ 0: that tb. pre.ent cbange in p.r.on~.l atfordt 0.. fo, ~b. re-organllation of the Indu.trial !b.r. 1. Bted 1B tkil par~ of tht countrl tor a well traln.4 ob.mil~ 1n the t1eld of Intu.trlal BYll.n., &nd it 11 A7 b.llef tha' on. I~ould \. tnlag.4. !he Ipao. 1. aTailable in tbe Depar1m.n\ of Publio H.alth and ir.T tl,. M.dicl~" and manT probl awalt & a&n tua11fl., in 1hla fi.ld. ,\ tb. pre~.nt timt Indu.tr1al !lgien. aot1Titi at .cOill UniT.rlit7 are .. ~. r.ly haiipt red by the ab noe ot ak1lle" al.1I ~ance in obl.btr,.. R.lpeotfully .ub.itt... , (Signed) Prank G. Pedley, 0457 Tbe Induatrlal Clinic. ,. <#;. ( ... - /" "\ . DEPARTMENT OF PUBUC HEALTH AND PREVENTIVE MEDICINE McGILL . UNIVERSIT.Y., MONTREALt N.L. Burnette, Esq., Metropol1 tan Ute Insurance co., Cttawa, ent. October 11, 1932. Dear Mr. Burnette: You haTe asked me to let you haTe a Itatement regardlng Industrlal hyglene at ~~Glll In t1me tor the JDar1can Public Health Aaloc1atlon meet1ng th1s month. 4. you know, I came to Montreal 1n ~ugult, 1927 to take charge or the industrial hygiene work at MCG111. The rlrlt aotlTlt.J ..I the creation ot the Induatrial C11nl0 ..t the l4ontre..l General HOlpUal. It thOUCht at the tlm. that the beat point ot contact w1th lndultrr ..a throuch .. clln1c to which ca.e. ot occupatioDal dl ..... might be .ent tor lnT.atlg..UOll and treat- ment. .l conelderebl. nWllb.r ot lUeh e..... w.re cUreatad to the Clinl0, parUcu- 1&1'17 ca ot lead po1aonlq, a.n4 cont..ot was mac1e wl th the 1n4u.tr1 trca whlch they CUlil. One plant w1 th an exc.ptionallJ ..Tere le&4 hazard ..ctuall1 ereo- ted .. new bulldlna, partly, I bell.Te, on our reaommadat1oza, &nd "Teral pluta twDe.. baTe lmproTed their working condl UOll., b1 In.talllD& TUloue TelltU..Ung deTlce. to ourr a., pol.onou. duet. ad SeT.ral papera haTe bee. publ1ahe4 on the lubject ot lead poleon1ng, copl ot which are enelo..d. The occupational pdlonlDC work bal be. oonailered a 1... Importaat actlTlt,r than other., partloularl, Oil accouat ot the t ..ot tbat the n~ bel' ot easel ot occupational poleoll1q 11 l1li&1.1 compare' wi tll othel" 41 ......1 1Ihlch afteot lnduetr1al workerl. .IJ.l eT14enoe poute to the t ..ot that ln411ltrlal ~rk- t ", era eutter in the maln trOll the NIle 41.ea..1 whlch attect the ,ener&1 population, I ~ and that preunUTe medlc1ne tar indultrlal .,rker. ROul' be dlrMt.. toar4' I~'I tho'e dleeaN' and not e.peol&l.lJ' toft1'41 the .0-caUM oooupat1GUl 41........ . \" " 11'01' thh rea.on, it w. thcna&ht that .. Taluable ..moe ooula be reDdere4 indu.tlT J. in p&rtlculv. a.n4 the oca.Jllt1 111 general, it 1ndu.tr1al health .."lce. oould r be tabU.hell ill the 18.1'1'1" 1ndu.tr1e., 10 that th. health ot the worker. oould be" brought Wl4u the l~l&te wpemllcm ot .. dootor &J14 a ..r... .l good deal ot t11lll d'Tote4 to wlr1ga oont&ot nth In- du.tri which, 1t .... thought, would b. lnte%te4 tn & IO~ at thi. nature. Conliderable IUOce.' .... &o~eTe4 ..t tlr.t and tlT. plant. oreate4 health depart- ment. 1mmedlatel,. under our eupe"l.lon, whil. tOUl' 01' tlTe other concenl aft sUmu..late4 to .stabli.h medlcal department.. Tb,ese _41oal dep&rUlent. haTe all g1Ten .iiltactlon and are ltill operatiq, but tile lndu.tr1&l depre lon 4urlq the lalt three year. hal _d. progre in ,thi' wort TelT 41ttlcult. .' .:~ ~ ~ .,.., , " ""I \~,.) ..... \ \r-"t:.v C "V VI \~, Industr1al Dental 011n10 \,~OUUV In conneotion With tbe work ot the lndu.trl&! health .e"lcea, ,. . 2. an lndultrlal deJl~al albic tabU,hed, ~be acU,,1 ti ot which are recorded in an aUached re-pr1n~. Thi. clinio hail tiil'pg. UHlt ellUrtlJ and 1. ha"lnc a cer'kill amouat ot dUtloult7 now 1n makina both eDd et. Indultr1al M.dioal .uloclation ot the PrOYlnce ot ",ueb.a .u U outCOJll ot tu lndultr1a.l hygiene work, the Illdu.trlal Medlcal U.Oelation. P.~., ..I e.t&blhhe4 In 1928. Thl. 1. a b1l1ncual j,lIoclat101l whiah carrle. on lndependent act1"1~111, and 1. allO conllderl4 a branch ot the PrOYillce ot ,uebec 14edlcal ..\aaoclatlon. Doctorl, Pezmoyer, MerCier, St. 1aqu.I, and Tee., baTe bsen the Iucce.al"s pre.ldent., and Dr. i&r4 and I baTe .erTsd al .scretary. The organlzat10n took an actl"e part at thl reque.t ot the Workmen'e Campen_tioD CoDll11asion, 111 ~attlD& ~he tariff ot the 1928 iorkmen'. CompeneaUon taw, and hal held meetlnge approxlma~ely bl-mon~hly 11nce lte organlzation. Montreal Health SurTel The Indultrlal Hygiene ~epartmeDt co-operated with the Montreal Health SurTey CoDllli ttee and prepared the lndultrlal hygiene aeotioa ot the report. Study ot j,abeato.l1 In co-oJllration wi th the Metropol1tan Lite InauftllcI COIIlp&IlJ, a aune7 of two Compe.niel Di1ning and 1I1111ng albelto., . . _de 1n 1ul.7 and Septeaber: 1930. ".I.. 7 Phy.lcal exam1nat1on of IOJIII 150 men ..I made, tosether with ch.lt X-raYI. aJUl .. lntere.UDe .tat. ot affairl d18010.ed, 1Ih1ch reponed to Dr. IAD- ot the Iletropol1tu Lif. InlUl'&Ilc, CODlJl&ll7, cured to pablllh the r.n.lta of the ltud7. but to dat. perallllOill baa not . 'bee. M-tti:r . . . ..18 __ Lecture. at MaGiU Cour... ot 1.cture. em lndu.trlal hYlien. laa". b... glTln .T.r7 7.ar to 0/ the third year med1cal .tudent. and graduate nur.....oclal 'IOrk.r. and architect Gen.ral Publl01;r J. uuaber ot plltUo a44.r..... bA". lHt.. ,1".. OIl the wbJeot ot lndtrlal hygiene. Varlou ~pu. ba"e beea pr.par.d tor publ1ca'\101L or pre..atatlon at eolenUtlo .eUnc aoet ot which are nolo I ha~ "'.......'Uq l'ertewand e41 torlal. to tbe Canadlal lle41cal. Aaao- ciatiCIIL lo~ iaaT. '&IN &at" a. Jo1Dt ec11tor wUh Dr. C1Wl1q1a.aa ot the . Induatrl&1 Bni.......Uaa of the C&JW.dlan PubUo BMlth a.oalaUaa .Journal. . ~~:~a ~ '. . . J. r.,.. . .taU.. ta"CNl'lDe the or8&tl= ot Di,,1.1oa ot Indllltrl&1 B7g1en. In the PrOt'lno1a1 BMltll Depl.1'tmant, laal been a4e to the &001&1 In8uruo. CGata.ion ud the Province of Quebec. _ tht. CcaI11110a hal reca.udec1 .uGh a Din.IOll to the Provinclal Goyernaeat. I Pre . .nt ~tlTitlel The In411ltrl.1 Clinic bl be.. JIOf'ecl to tbe V.iTer.itJ 1lJl4el' the iJllla41.te dll'eat10n or Dr. Vance ".1'4. n. wPlrTl110a ot '\u }Ilu'\ _cU.c&1 4epu'tlMllta Oall- tlnue., and III ad41tloa, two n actlY1tl ha"e bee tar'~ aDd are IlO. ill operatloa: (1) a .tudJ ot meraurJ poboaing and (2) I.D 1Ildu.tl'lal. he&.lth IUrYey: 0358 ~ J .' . ~ 3. (1) OUr a tteDUon was dran a year or '0 &go to the JDel"CurJ haZUcl in onl ot thl plant. out.ldl thl Clt1, ot eXperllD11Dtal work had and al.o to the .r&ot. that a rllatlTl1, amall amount be.D dODI on indu.trial mercU%'J poi.wlnc. 'lbl 00- operation ot thl perimental .tudy Department ot PharacolO1 at MoGUl ft. obtalDd and with dogl 18 now in progre.1 to alOuta1D the D1n1Jlwl an exper- milsable concentratiohnorotltymbeercUr1e"a, dI,n. aTlhri.Itut di,.lasDbtelcinlpgattlendantoheadt aenptulrbelilc,attrioomn at thl1 atud, will a the Indultrlal Hygiene ~dl'l~ ,.~ ~~ ~~r A) . ..., . (2) In co-operation Depart1ll8D t, am 111 th the Canadlan the Department ot Tuberculoal. usoclatlon, the Industrial Hygiene at ltt:Gl11, ProTinclal Health a atud, haa been aaltaaortewdithwirt.htepra.nrtcioeutloargreente.rraelnhce. atlotht.ubSearmceul2o,s0i0s0InwoIrnkderus.tlrnlatlhwreoerko.orma,pabnulte. 1.-" (. ~/." have alread, rec.1Ted a 1t 11 hoped to continue complete physical thil surTey .0 a. Ixaminatlon, with che.t X-ra,., and to include ~,OOO plO1 ' in dltter- f~,'rIrI ,t'I!,.""' ".. ent occupat1onl. nanced,partly b, Thl1 8\11'''''Y hal been the~ovlnclal Bealth under .Y tor .. Y.u, Department, partl, by am.J.s being tithe industr1.s con- -\- t. (' \I ~ ~,...,/ .",000 J'..J I .L~ cerned, and partly by~ourselTel. . " .,.'- ,,~ . Th. $2:5,000 prOll1s.d by the IIItropol1ta Ute In-urance ba. all be.a paid, and some OU%'J .tudJ can be 1. lett to carryon the work. .e are ln hope. tbat oOlipleted within thl' apJq"oprlat1on, wt it will not be the . .po l ' l l to tlnlah the lndu.tr1al h.tlth .urTIJ unll additional tuDd. are torthco.inc .An aot1TltJ which we haw beDd_Tourlq to e.tabl1ah tor .0lIl - - yeu., 1. a co-operatlTe health .,mce ',nloe at thelr Il. AD ,DdeaTour to plant. too -..J.l to prOYld. ma4e to pt W ,nl0' under a complete .7, tlD&DOM bJ the companle. 0W th....1T , but Tulou. dittlcultle. pre.'Dtld, ohiet ot which ... the ecepUol_ ot the emploJ,r. ot tt. practloab1l1tJ. Slnce thl. succ.aaful In Phlla4.1phta and Budaon Count" B.w 1er"" 1t ..... eche1Dl-ha. been 11kelJ that lIh,n 1i ,., b.tter time. RoJ&l, !dard returD, lt InetUut., a d_on.Vation e1llploJel'. m1&ht w.r. 841 perbap. 1Jl oo-opel'atloa with the be conTine.d ot th.. 4.elrabl11-\7 of nch a r:--~~ aohllDl. w.. t l 'thie would b. ot Talu. to the o,.,...,ttJ ln ,11t.ral, aDd to thl lD- r du.trite attlot" iD plU'tioulu, and m&ht be ot aetual 8Ccaca1o ftlu. to Jour o. . . . amplJlJ. The. . are tile _1Jl tut. in oonuoUon with the lDdu.trlal hJC1. . work at )6)G1U tJ'aiT l"~"':: . ~ .J:: .~. ~ ""-..... ':~ ....:; ~ FGP/IJI.. ~ f-I-~ ~'f""j) , C.(""""'~rr ~ l~ G. PacU'J, M.D. HEPORT OF '.I.'IIE PHYSICAL EXAl-lINA'!'ION5 gXAMINAr.II ONS OF ASBESTOS WOBKERS ilT aut;..;Jif<) AND THETPORD MID'S, QUEBEC )'IiI Tha report herewith presented deals with the examination of '141 IIllllployees of the Canadian Johns-Mah- ville Co., Asoestos, Que. and 54 employees of the Asbestos c_.'orporation....-.-o.. f C. an..ad.a..,. the Keasby-Mattlson Co. and John- son's Mine, all of Thetford Mines, Que. 1,0 of the men of the Canadiam Johns-Manville Co. were examinacci b~r Dr. D. ~r. Stevanson and Dr. Joseph Wyatt, who performed the physical examinayions and X-ray examinations respectively. The other wxaminations wel'e all performed by me, except the X-ray examinations. ActUally, Drs. Stevenson and ~'lyatt . exa.rnl~ed 57 menj but since 17 of these men were re-examined by me I am including them in my list. Drs. Stevenson , and vTyatt carried on their wo~ in November 1929. My exami- nations were done,'" in July 1930 in Asbestos, and .~ 1930 in Thetford Mines. in Septcmoer The Asbestos andThetford groups are very dis- sinilar, with, respect to age distriibution and 1tength I servica in the asbestos inpustry, but racially and omically tha two groups aret much alike. of econ- Table I gives the age distribution af the men and Table lIthe distribut&on according to length ofservicB in . the~dbestoe industry. . , .... . .. ,f; ~: I ~ t .i, _, I .... " '. ".,';' ,.' .'. ~~ :,": "',;,11t 1''"" "*'"I", fl'. -~., ~".1 ""t" {'" .~1".,.._. ,. .'",', r..:lt~a.: 0 .i!"'lt.lJ"'OC~ .'W .. w.:. ,.,'-t'...,.....t....p ...,.,,..~..iOJlC r 1 .c. . ,. . .w .. 4) T" .,L- . , -J~.')'".'. ",I (:~'1, lltI~ 1.".'1 00 C"""'." :,1 .-. '-' .' " , . ", .:" _.w. l", ~ C .. -:"I ... ~ II """ ..' . . . .::tJ tn... .... " J . . .f:!.I...\. r. (.1."..~..". '.. oI f ' "', , i r i :! :'. j, " : " " ! oml 0 (\11 Y tho 't?1o groupIS . nro muCJ.h t'.11l:G. . ;. ,. . ~ Tn.hla I r.lvOG the n~~ t13.F.1;r1bu~ion at th!, anl~r. i , t'I'I~' l'nl.ile II tho die trl bntlo11 [I.ocord.1r.r, tu 10:;1; th 01: I' f'".': ,i,' ! f '. .' j .: I , j r. tl10 noboctoD 1ndus'tTj. '. j~ ' . " I I . . ... .. ... . . ......... . .. . ... ;' .' ." t.: ......" '.} J. .J .. '." , -: ~ , ..; .\'" ,.,_.r ~' . ':'_ ..'..' , .1"!.1"', " 0,'.\..". 'L"'., .......'. ..".."..,~. nt. o .., .. en. .- .'.: ,.Ij .,.' l c.:'""It'"J o " ..".. 0-' ,1 ..,,-1"'...1 0"':".".,"...f.,. ",. ,",,.a.'...1.... V..AC' ('\"1':......c....,r.. .~..l.' '"U"Jlt"J .".""r,4) r.).'l C"~':_',)' J'-"~tI:~''l '1.."'., .'"..''.. .\ ........ ,w.,.. .".U l O ". ) ... , I ' . ,.,' . . . -":''1.,"..',.. ' . , ;t'7't n.. . .''.'J. .,.:.'.'.''.',.&. . ,- ...~, '" , ."..,. '. J:~.i.l J ~I~il.:t:\i'ti j.~l1i.~'::. I. (: to ... ; , :\ .\ \ \ \ t''r.... l(!o in tho nslH~otoo . j.ll(!.ltnt:a.7. uut . rc.cjr~ll:,' f)~il nco',:,- omlcnlly tho 't?7o groupo. nro T:"~oh C'.11l:o. Tllhl(\ I r.1'VOG the nr.~ a3.r.tribu~ion of th~ I;ll~'. r.I'~ ~'(ll:le 11 tliO ale trll:mtiofl (::.ocord1J1~ tu lom;~h of. n"'~:.i r. j r. thr.l nob-o etC' n 1ndustl"j. 00244 ... , J~~I' I !;1 , ".' ~ :. ' " ' -- : '-I! ..... '.~l"'~~ ,.. j~u':"~r ?c rc C'n ~..'" ... ,) ,!". - ,'. .. '---- . ----. '. --....... . ~ ----.-~------------~~ ~----------------------~~~.=-l----------------------------------------------- _1- . _ - ::;: .., 2 : - ',' _ _.~,.-_.___________:f";;.......~.;..____""!-______..:;.t;.._" _.0....._______________.;.._____________~ _______ '. ... =". -- -_. __________________ ...... ;:f_._____________I.;'~ _________~______1=-7__.~ 0______________________~~r-~) '-- t_'_.~:_'_________ .... . .. ,.,,.I.,\,' 10 _.n ,., , ..--::-2...-:..,.." _J.~ ),7.1 I e'.t __._:' (L_!..:~______.1::..0;.;._________-=1:.;.2;;...;.0..:._____________.;l~::-_'______________';.'~( -,_1_____.__.. _ .,.!-;---..I.'..~-.,______ 11 _.0::..::..______....____..:1:..;;0;...;...0.;;._______________ 7_.;.._________....l;;;;:....~_._'_______ .... __ _____________-______ ______ ... ___________________ !,~~: .~ ... ~ 1 ~to:~~ ~G~ ____________ ~ll.l .,r',~-_ --!"..',~.~------1~-----------~~0~.-7-----------------~ ~---. -~--, ---. --~ ,,~ 1 0.'1 ~ ! ..(' ., 1 0.7 ... ., .,. . f , .. . , l. '0.1 . . ,------=--------~;.-.,-----------,-------, ...-. -,',--- _....... - . .... .. . " ' ! , , _::I~===:::=~=.==1=.=L=.==_===========l=O==O==.=n=t=)::;'~-~.:':-=::'.::;r,'1:.::::!-:==:-=-"~ I.~D ... . ----~---- . .' ,', .. . 'Co . t' be .) ---_ .._"...... . " I . Tit. L E II r - I 'I Atbostos I Thotford O:t I );r .1"0 I r,",1 0-.0.,;;.._~_.:.I:;.;.";.;;~';..;'l..;;,o_r_ _-:oP~o;.:;r..::c..;;,o.;.;n..;.tn;.;..!',.o~_ _ _;~~',;,;,;':~;b:;.;C!;.:r:..--;.__!':.o;;.:r:..;C;.;.Il:.:,21.:.,:t:...;".C.~.,.,_ __ *" . I o - ----~-- ~--~,------Z~l.-:!---,~,--------1 ~----------1.~0~0----- G5 I 46.1 I G 1~.0 10 - 1-\ 11 I 7.0 I 6 ______ ______ I '/ ;\\\-_!l-,!~\O_~_-~-_~-~~1'--!~l4-_-_-_-__-_-_~~1-60_-_~~~I-----.-_.~~.~~1~~.3-~-~fI-_~------~1~9G-__-~-~_-_-__-_-_~~21,~~G)~-.~(-7t_-_-_-__-_-_-_-_ I I ~ -r..!-) -- -,9~----~--~2~-+------~~1-.-4~' --i ------~--9 --~--~~:~1-(j--'/ -------- I 2 , 1.' I 1 . - 1 -..; ,0.;:;.5_ _ _ . _ _:1:---------__r----------- _;-!5 - =-, ____. I:--...,--=--2=---..-.,.,i____.. .t .t1.....:.!~' I I I .'i 0 'r ]I. L : 1_ _--:-1_ _ _ _ _ _. : ~. :. 7_ I=__ ____=____ 141 100.0 -i-.=--.: 7_liie II . J 1()0.0 It will bo no tea thn t \.hilo GO l'oroou1; o-f l.iJ() , man in Thetford Uinos were ovc~ 40 yonrs of nco onl~ ~o }\eroent of the mon in Asbnstoe ,,'ero over 40. Ana iur-' thor with rotpoot to loncth o! Dorvice 83.4 Foroont of the men exr.mino4 in Xbe1,tord 'Uinop hndT70rko4 in the BO beltol in4ultr7 for .10 ~oDrD or more, bu' in AlboltOI onl1 2~ percent hD4 ~rkod tor moro th~D tOD7oaro. I I . I !I\ble III .8ho\18 tho 41cp.o 81 t10n of the mG~i in I I ynr10ul pa~t8 ~f the' 1n4uitr,r. . Sinoe tho numbere ~re ... , . ' '... '"ril~ll \,rolu1 OLl(Hll"\'~ionl'), 1,,01=l'i.;it'II ('i,'" \:Ilt~t'i. ,, i' . Anbontoo tho occupr,ti9DO nra d1vidoti into ~ crau)'c '. mill, pit ana !CLotOr.n in 'Xho1,;:ord I.:1nou ollly tjl0 !irrt t,.:o ooauptl t1 om,.l Cl'onfO firn uDod, cinco no n.obonto!! T.'lo:mfnot~r1nE.t 10 or:rrioa ~n thoro.. .1\11 tho m~n of tho 7het!ore ~lnac r,roup oould bo ~o clrco- i1".1 au. but 5 man ~era oxoluiloQ !ro:l tho J,cbcotDFl r;rol.Jj) e1noo thoy dlel not (lllyonr to ba e::poDo~ to 'Wl un\~Duol MOunt 01" dust. ~ h B L E III - , I ) . . .. ~ .~. ' a...'...:a. ''~'c lGr~vTlnoo o f l ~. :~111 ~ D:-1111nr; I! "f1t; j.'~O~~~j.7" "JIT. r-'J.. r.--:.. I.1, .I'. ,. J.:..:~, ! . 1~ ____ __ ____ ~~~~~~~~~ ~~~~ !~:= j l=l '1 n1 1 ~!~ l.!~"~ il1~1a r.~ " ir~ .i' .t ~__ __ ,__ ____ t --1-Qr-:,~--~~-_'~----I -~~-(6j--~--~---------o --~6-----! ---~~~------------~1~-~ ---~--------~-:-i'--------~u--------- ____ __ -1 __~r:fO=='.:.~.-_1,___~-..7:.:~::3~_~_--_--_~Z_:-:.1-_--_.--~----------~--~1~~~~~7-~--~-------------4:~.-1-~---------~ _.. ----- -- :';.-~'l --...1. ,____~l=________,-_-_-_--_-_-iI _ --_--_-~G--~-----~1------ .. _____ _;!~_~~~ __=l n;.;.)_ _ _ _ _ =1________~1_._______________~!I______~1~~_________________ f' 1 1 I .'" a' I -----------------2-7---------------~o-t-. -. -, ~-------------.. ---n-------- 40 .. k4 . Tho pnet ! oooupnt1onnl h1stor7 in ln4uetr1oD otbor : thnn the ,1 asbestoB 1r.4uut%1 t~D i Bir~1f1uont on17 in '& Olu,'ee. Of the.e ono boon 0 Crain lnspootor 002~4 ,. -t 6 :;onr" nncl eo e~:l)ODO~ to vor") c.1UD~ OOiiu.1 tioJ1n. nr.q 11,(1 bonn n.l~ un:1orcround 00'1>01' ::linor ior 18 yot~ro, one 0 oorror rninor for 2 y8~r8t n .fourth llna 'r.ol)~od in Q. oOtlont .plnnt !or 9 ;(onrl'. ona tho :lfth ".:14 Orero.tou a. ilTl11 in nn iron minI). nan last 1r..d.lvjdunl oho,-:ou ;;-rcy ov1Conoo of r.~ow.looon10D1u. tho othoro iliu not havo pno\""';1ocor.ion1s. In Tnhle IV RI'O civon oboo~vot1o~o or v:01ci11; ill Diroctoro and the Aotuol-ial soc~ ot7 or J..r.1orio~, -. . .l:"t'~ .t; ':1 l." /.-.,: .0...-.,. Ir.l"~~.~, I'.,-J,' l''1J"r"' ".".. t",,} , f'-.,(~(.}.u"TII...~ t.!,"j.lv'\ J.r...!. . . i : 1'orZj0c1 S'\r 1;;00 ,.! !he groul" 0' :10,000 ct'.lo 1n4uotr1nl TOr~Or8 1-0- w I in the al,o.,o. \\(ll'lo . , 'ItlD at"a.ln,1 bj' tho Un! 'bod rulll10 Boal '\b 80"100 ( 000 h'bl10 Uoal ~h Dullo1;1n .. ... lio. 162). It will be notod that tl.aoro 113 very li ttle distinotion between this larae Group and the group of .: BAbosto! workers 80 for. BS decrees ot overweiaht. or underweisht aro oonoorneA . In the oonsiderntion o~ in~ividuel defoote s~mo interootir.g faots hovo bean !ound. In this study onl.y the 101 mon nt Asbestos and tho 54 mon at Thotford tanes nro oonsidered. si:1cO the records of tho mon exnmined by Dr. Stevo~son oro not stric~ly oompnr&b10 vdtb mine. Di'VidiDS tho.mon into t'10 croups aooordir.B to whether the teeth 4i4 or did ~ot Deod attontion. of the . ADbostos grou:r;' 49.5~roquirod attontion. and ot the ~et :Corel IJinos gronp 51.8 ~. Acuit,r of hearing ~s tostod by means o~ a . ,-:ntch. (~ om heQrine. "wll1oh lu s been' tOlltod b7 on aUdiometer, ;. 1'!8D oODs1c1ore4 i nO~l, and used . as 11 oto.ndard) the , .toh ~ ",0 It 11 D4m! ~, te417 Y0r1 :rou~. I,n nOis1 ooou- r a t10ni 1mpn1re4 i h8or1:11 1 1'.. ; froquont17 ' foun4 in the oldor emplol,'ea. 1 Of th. 101 men ot ADb.atoa 10 abo".! a,fin1 to 1 benz-lnG,loB 00244, . , " < . ' .' ~rou~ ot adul t8 ,.:111 Dhow ',n c1rn11o.r pioture. In ~hetford U1nel 28 o~ tho 51 men suf~GrG4 from woll mcr}ted heo.rinB 1'081. . This j 8 a Tery hi6h poroontcao, and oomparable to ~o.t ~ay bo ~o\md 1n'~rTin~ ebode and boiler sbop<s. /,11 thoso cen, exoept. tn), , had beon exposed to loud noi~e in their ~~rk for 10 yoars or Qore, ODd it is reasonable to auproDo'that noi so played a part in thoir honr1r.s d1ef.bili t7' ' nto n~bor of mon ,,'1 th iri"eoted !l'O;:SILS ~s 27 ~n Asbestos and 13 in ~hottord tanoo, end almost 1ndetico.l ret10 to <tho totnl in both crOllp!), Dofeots of tho TnY:::OID woro raro, 'mon in Asbootos and 1 in 7hetford ilinos ha" enlcreod th),roida. ,nood1nr.e worornoordou 1n nll mon ovor 40 yanrs oi" aso. B'1:oopt in oT.cort1orlD.l oircw:lot"noos tha blood rroe"nre 1':f\'ft Dot tC\ken in the young~r mon. COAsoquantl), al tbOllGb< the .r-roul's oXL'::1ined in Ttl0t:['ord Ulnei wna smnller than thot < t in AsbestoD more blood . prolr.Uro r.a41nr,e ".~o to.kon thore.2 men1n Asbonto8 bn4bloo4 , I proeeure. of ovor . i 150 and ' ' 2 ' bloo~ ~ro8Duro. unaer,100 Jr..1:l. ot m.rour1. 8 DiOD 1n' !rhltfor4 Ulnas . . I h~4 bloodpr'18~'8 qt OTor 150 and 2 blood proBDures un4er 100. 00244 . . ~.:\~ ,1. '.: ~ ~ .:, " . .'- !lb. Inoi4onco ot n;:'.!-::~!1, 1ft ot lr..terent from th~ oompensatlon 8t~d~o1nt. In .AsboPtoR all now om},- ' . ' . . ,. . mont. Thore were" onnon.o! 1ncnlno1 hornle d1"oovernd nmons tho 101 mon oXo::11nod thoro. In-addition to thGSO 5 ~en hod been opo~atod upon for this oor-Clition . In !rho lford !!lnoo llhyoicnl e:t~1:linnt1on is not r0'lu1rod bofore emploYJ:lont. ~here woro 5 onBo~ of Incuinol hernia ~1ona the 54'men ox~~1nad and 2 onsoa nlich hod beon opernted upon. Some Interett hns or! Don in C0Zl11ootion Y/1th tho ooourronoo of tho 'EJo-onl1odAS:t3~3TOS con::s. Thene nre uouf\ll~ 1,1n hone o1zo4 olov(\ tioras o~ tho ok1n, nomo- ,'Ilin of thoae Tlore detected In the AobootOD mon probnbly cluo to r:t:I lr.nor(l.noo of thoir rp)'lonrance. S of tho ,Thotford nine EJ mon hoa thono r.rol"'thn on tboir handa and sovornl others rOl~rtod hnv1nn hnd .thom Dt ono tlmo or anothor. ..' ;, . . 'i\ , :' ;." 1 \ " ,.' ".- .. .., ' I ': t . .1 ~;.' i.1 ,I I , t ~ I , I ' . 'I.J .. . " , l' I . : " '.,."+. . , .:' ' ,or. r . L U n G S Of tbe 101 mOD e:mrnInet1 b~ me at Asbostoo on174 Buf.rero4 from definIt.e ~lrst,8tB8e p'nel~oonn- 10818. Thepe will not bo conaiderod onacoount or ' ..~ ,",.'i~ :.:.: \. " Of the '0 rnen oxn'n1noc1 b1 Drs. Stovoncon I,,,..::",'";:, end r:yott 14 wero dle;tnoeod re :first etnce )meW1IOC()n- I.. ..',~"... " 10 D1e (n.ebestools 1) (I run lncln41ns the 17 .non ox- . a:nIned by Drs .Stevenso14 and \'lyott ana subooque.ltly ro-ex0J:J1noc1 by.me In my cron), of. 101). ~e mu' ch lODDor ino1denoe ot pneumoconios1s In my croup of mon may eoom .st1rrr1 Bine. but 1 t Duet be rOIilOTjlborou that tho X-roy .,.. ::..'.. ' ner,ative8 ,~ere not rood b~ tho c~emoD.' In ~ r,roup tho ': 't-rny dlo.r,nODG8 wero mae by Dr~ LIorl,.,'othor of pitcher, O;:lnhomn, nna 11.i ,tho otl1or aronp' tho Jr<~;a., 1ntorT'ro~ tnt10ne "ere b,. Drs. '7yntt nnel ;;".J,eeEtst . Further tho G~:!""'..->.\up oxnI'D1nocl by Dra. Stovonson ona r:yntt "'oro, 1n, .E~on- eral, older thM thoso 1n m;v group. Of the 54 men '~4Inoa .at!hottord Uin9R ~4 ~re 41nnD08e4 b7 X~rn1 a8 8uffar1n& from'~nG\~ooon1oD18 (nnboatoeia), of the80 4.,W8re d1csnoaea DS. probnbl1 tiret etar.o asbestosis. e' 01 eorlJ .tDGO, , AI a,finite fIr.' .'teS8 ana 3 al 8000na Ito" til. pert-ln.nt. tAO~~ "catlr(~l~C t.b. doflrU.. oaDOD or ... : ..,1".lool1. al". 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' :':,...".,..: .:....I:..-,..,:... \': ~ 0' t . " ; ..I' l , " , , Taiorle V1 (cont.1!,~_e.;;.d",")_ _ _ _ _ _ _ _ _ _ _ _ __ . _.. _ ..~.l.:wn"._ -----... _-. -, , . .; 1 1 ~." '1' .' (~"r:'11 p., ~, A.1 (J'tJ1:, ...l.)') "., ..... lot :- I 'h.1 I, 't (late) l"~!.1n~ L:,,:,ol 1n ;'11. ,, ;':12'". '. flrll! ':1' , ~rD. o~r:\t.ot 1n' :0.111 ..::.1; 1,.,.1:;:.t. ,j.~rn ol~l!r ire :Jl11 1:'1 ~r.D. ror..."\h a.U l. :' yr ...111 M.il, r e r .: o \lr r, ll .:\11 , ,.I ;r/1. j'l'n. r',r'!'O,\n ,;.111 ,"'\ :j1:1 .ml1hrricht 7 J~rl'. n: , Gy.i;:t.~ -:0 , no 1l1.n~rn1 el. "I'. . 'I) n.:"::''':J::.~ n::1 ,11 0 ~ t.. L.~. .,., I!.:.t.....r :.;'\1\ loLl'.grcl,lo n1 ". cc~u;h.-\;,:'\. :leo n\) ,,~'\:. t."n~ :It,'rc,l:lJ!t If'rr r : ' ".:at. o'"or rl!~iaL 1,,:,:. r .. '''''t,. .t,. Ctl!. U,,\. "'tt' rl.. " "~ ' .... "'1'.J.'.lilt 1 Y~r 1 ' U ~r h1 fr 's\. f .....~. U 0'(,.:\ ,!II ',n ;.,,' 't',' :' "I.,' crt.'.'i: ,n 'IIr J. ".: '1~1 T. n'd, :". rl.; '. tJ., ,.~ 1'.' l . ;\Jr l~~"" I~.I.,' n" ~"'\'tt t ":',,". O~ : .:')1', -J 'r.:tt:,; '!I l't)~r /'1 ". J:C~l\. :t~ 1"'& n ... no ,1mQrlal r~:;-I". \, ..! ; i , , I: . ..... . , ..... :~_.~. ,',. ..... "'! ,.... ~:.:~.~,... . :;'~.. . ...'. " .. ..' __ ------- ._-. .. .-."~=\", .' . ... .',,',,.e I ,. ' . ' . '~I '. '" . !-.~ :~t. ."...,.,....'.............".. . ita,,' -;. . .. .' I\. "Ul 1,. no"~" . "iUl.,,~:Or , .. , .. : .... ~= 1'..- 'D~~i' O!\~ l1~.cd .,.1. .A .to,,:.;_ or H.' ... -... D".O"l AI tll"" :.:;.~~ ' , , ' . . :' ..~ ... , .11.0'It.o"1,,, 'l':h110 .. t'Lo"\.Dl' t7 tIer"! '. I \,1 ,.".,1.:l)r' ,~1 "3r. cu.",nol.,J .' ',: &"1~~:"':-:'''~' .', '., 1.;\0 ':"'" I"~'~. ,.~., . 0.. tirot. r-t.:lt;0 I\~; ;:t.~:"nl.l ,', OX" . ....... 0." 1no'1 ",- ;'la"" f, ,'" ';::1-~ hlln1.~r;!,,~ 1. n-,1. t.o ftn' :; 0., . 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"Uon~ or 4t drl1luro ,'~. , \,,"oe or I'\Dl.o,\.O,ln,o: . 1.411 ",l:arl ~7' "'01'0 Oi\IOI "rt:~:tt..ftl0 I\n'1 II\.' Tt'",.:.o,." 111 "'.,. the "~tr.; on1; , CCt" JIO"'~ a-rft .v1t",,0. "ltrvr~,. to!., '100"'0, 1 'r.,1'h.nt,11 "h,tr. 1. 1i "" "0 ~i.\r t,~ In tho h,\lnra 1ft 1 &..\1.11 ,~-o'i''I'' un.) IStl'1nru. Tho .111 "'01' or:, , . ex:.o ' t.o t"" r,ro~t,or "'7t. , I DO:loqn"rJ.t.lollo t', ,,''I1n "h., .1rl!1tZ ,,"1 1 t, 1, Mlo""r ,Urflow to . 'I t,o, unJor"t.4nl ,.., t.lao h1Gh 1nol.. :" "":t~ t.ho dri11gr.. 110""01', it. mnl I'LV not, ~ 1&,I\0t or n"'ll ort.;':sl, .> ! of l"Loro"lo toa nut.!! \1", ;': ":/.::'.':" .. . ." ...... .... ~.' ::~ .,.: :~:. '.:. :.," ' : :~ . ',:'. ~.:.:. .:.~:: !,' ''''~:'~'' ~ .. , . .' .': '\ '.1 t .:' ... '. .,: \, . . '. ~~~I~'" ,.__:..~;;'..J':..~._~.~ .i'::'~. _.... '. .... ."." .... " - . ~ \ A brief revie'., of curreat knowledge and analrsis of tuberculosis mortality in the albestes mining cOIDo"lNnit,. , of Thetford Hines, P.Q., Canada ~. Regent develo~nts in Canada have focused attention on the question or the~ r.1ntionshl~ between asbestosis and tube;'ulo.i.. A.~.to.i. has been declared a ~ - - . compens.ble disease in the Province or Quebec, thus increasing medico-legal interest in t~e establishment of this diagnosis and evaluation or any contributing tactors. . Auto~sy 0: A$bestos miners has disclosed evidence or active tuberculosis and asbestosis , 1&2 " in the S~ individuals. In Thettord Minoa, where a substantial part. or all the Asbest.os in Canada is produced, the JUort.ality trom tuberculosis has in the past 16 years approximately doubled in contrast to a s1,gn1licant decline in the Provinci8J. rate. These; developments have materially helped to create the impression in the I Province of Queboc that: there is a causal relationship betweea tuberculosis and asbestosis similar to the caretull,. demonstrated and generally accepted relationship between 811ic081s and tuberc~psis. Observations in the United states Previous studies ot workers exposed to asbestos dust have not disclosed a higher incidence 0: tuberculosis among workers with clinical and X-ray evidence or asbestosis ~ indust~ we,,~ Lanza3 in 1935 concluded that asbestos dust did not predispose t~ tuberculosis. In . xicdn.tion of 126 workers in the. , . in tho United stat, S3.U to have de.f1nite X-ray evidence ot asbestosis. Two cases or active tuberculosis were . . lound. Ona or these was a worker with asbestosis t d:;'- . In i9364 Donnou,. reviewed i~ra;y!illll or 1Sl workers in asbestos mUla ~ctiv. tu~.nn found eVidence of asbestosis among 34.4% or the group. No .a. of' wore round among workers with asbestosis. On the other bahd, 1n the group witho~t tsbe&t,os1:l he round tour active casea or tuberculosis. TWo of tbes' active ~a8eB\ ,I' r " in the asbestos industry, six and ten years respectively. Donnelly , , , : ~:;.ell.:.d..,d that there was no tendency per se in, this type or industrial occupation ! \.0 .XAcer~ate old 'tuberculosis lesions. .,, .'. , , , - I MePb~eters5 reported in 1936 &~ X-ray survey ot~o persona exposed to ~"" utestos .,:dust He round 25.2% had some evidence or asbestosis. 'Three cases ,~, . of active, tuberculosis were found. No tuberculosis was' found in workers with " ' , - . asbestosiS. The ~hree individuals with tuberculosis bad been exposed to asbest08 , -- dust 6, 9, and 10 years respect1:vely. In five cases bealedpulmonary tuberculosis .' and asbestosis were ~OUDd in association. The average duration ot exposure' for ,(,,_----:-- , the 5 was 10.4 years and tor the entire group 10.2 years. McPheeters decided there is no accelerating ettect ot tuberculosis on asbestosis. I In su.mmation ot this evidence' it can be said that X-ray and clinical stUdies ,&lIlong asbestos workers in the United States does not reveal a significantly greater , -, smount of tuberculosis than expected in the routine examination of workers in any industry. Moreover 'there i8 no evidence from these studies to indicate that long exPosure to asbestos dust activates or accelerates the tuberculous process.' Both these observations are in contrast to findings among workers expose9- to 'free 811ica. Canadian Observations '" -) - TABLE 1 Asbestos Thetford Mine!! . fF ~xam1 ned I f' lU 54 % with more tban 10 yea.rs exposure ' 22 , 'TF 'With asbestosis 18 83.4 24 .( % ,'With asbe stosis 12.7 44.4 Ooe case of active tuberculosis 'Was round among the 195 individuals examined. This is a very sa.tisfa.ctory incidence of tuberculosis U10ng an industrial group, even toda.y.: For example, it approx1mate~ the indicence in a survey in 1940 or the . garment trape whe,n 1 active case 'Was found per 165 individuals exB.mined. 7 Pedley8 found ,that I the tuberculosis mortality in Thetford Mines for the years 1926, 1927,and 1928 compared favorably 'With the tubercuiosis mortality tor the Province ot Quebec. ' , ' " i' ' '- " " TABLE 2 Average Tube~ulo5is Mortalitl for All Ages ~r 100100 Place 1926:"28 1940-42- %Change Quebec 12).6 78.6 35 - Thetford. 1.37.9 252.1 ,83 1" ;. However" since this report of Pedley there has been a sharp change in the tuberculosis mortality relationship between Thetf"6rd Mines and the Province as & whole. Table 2 sho'Ws that in the :Pro~ce or Quebec the average rate tor the three years 1940-42 has dec~~~ed 35% compared to the average rate fox:, ~'he years 1926-28. " ,:.' ''''''-- - .-~-- ...,,----- to 8'Xperienee elsewhere in Canada and the United States. ,On the other hand, . , Thetfot.d Mines for the correspondiOg period tuberculosis mortality has 1ncrea~ J!)ore than' 80%. ,Tbe' ~bvious existence' of a serious tuberculosis problem in Tbetf~-~-,.~ Mines bas Iled to speculation regarding the 1n!lutmee of asbestos dust. Tuberculo~is Mortality Study ...i' . .' It the industrial exposure to asbestos dust is a significant factor in eneer- 0,'0 bating . or accelerati.ng,. tuberculosis one would expect to tind a significant dUferenee. . ..... . . in males over 25 years of age since, in Thetford Mines, practically all of this part ".. ' ..~,' . .' ~ t of the population not in military service work in'the asbestos industry. Socio- ' . economic factors are also sign1!icant in relation to tuberculosis. Therefore, . . '.' ....... co~par1sori of the tuberculosis mortality rates in Thetford Mines with communities in the Province of like size, medical and public health facilities, soc~o-econom1c I . , ~Jr ~~ and, racial characte~istics is important. Dublin has pointed ~ut~ ~. socio- economic factors were dominant the tuberculosis mortality rates for both husbands ,and wives were s~arlt affected; where industrial factors played a leading role . , the standardized mortality rates for the husbands greatly exceeded that ot the wives. 9 Through the courte,sy of the Demographer of the Provincial Ministry ot Health' '" and. Social Welfare, Dr. Paul:'Parrot, we were furnished the number ot deaths from tuberculosis by age and sex for the years 1939 to 1943 for the cities of Thetford Mines, Rimousld, Chicoutimi, Cap de loiadeleine, st. Hyacint~e, St. Joand, an4 Valleyfield, as well as tor the Province and the Dominion 'as a whole. Ot the six co:=.unities picked with these , characteristics in mind, the town ot Rimouski was thought more nearly to compare with Thetford Mines, except instead ot asbestos mining it~ princ!,paJ. industry is l.uir.bering and wood' finishing (see Table :3, P.4aY\ -_ __ .. ~~ .. -." .. - 5- TABLE 4 \ Shows the Average Mortality Rate by Sex for All Ages in \ Province aDd in the Seven Selected Communities \ 1940-1942 \ Tuberculosis Death Rate per 100,,000 All Ages . Male Female PROVINCE OF QUEBEC 77.5 80.8 Cap de la-Madeleine 55.9 44.5 St. Hyacinthe 84.5 90.9 " St. John 75.1 109.8 Valleyfield 101.7 S5.3 . Chicout1m1 141.8 149.1 Thetford Mines 190.1 223.9 R:il:lousk1 171.9 2137.3 ;Poculation letforci Mines 12,000 jnouski (incl. suburbs) lp Madeleice 10,000 13,OCO aree Rivers. 45,800 hicoutil::.i 25~OOO t. Hyacinthe 'alleyfie1d 18,500 20,600 TABLE 3 . De sc riptive Dat~ on Selected Communities Industries Asbestos mining Health Health Officers '" Unit 1 1 Pub.H. ~rivate. Nurses Physicians 5 12 Pa: ~tio .J:>bys. tQ . . lum. bering, w.ood 1 finishing . rubber mfg., 1 steel foundry, bag" mfg. silk 1 4 10 1/1000 '.' 1 .y* 6 2 1/6500 paper" linen 1 mfg., rubber" iron 1 9 40 l/llS.o . t. aluminum, pulp, 1 paper, iron fdry., c~ay products l,-t-;,\ ~ 10 19 :iJ./45 00 (incl. 7 specs.) textile mfg. 1 1 i-:-*~ 'F- '6' 14 l/1300 . ., munitions, other 1 1 -5 10 'l/20C1J war industries, cotton, silk ~!ull-t~ health officers ~ including 1 dentist '. I'i.- X- including 1 tb. specialist '}i;~*"* including 2 full-time physicians . 't;: ;! . .--------------~.~---~~~,~'----------- - 0- I~:f~ble 4 it. will be noted that three ot the seven ~owns tor which data a tuberculosis mortality which is appreciably higher than the. frovinc1al rate .. Females in Rimousld have the highest. average rate tor the years 1940-42. !Fex:ales in Thettord. Mines have a higher average mortality for the corres- ..... '. I . . ponding' pe1rioc1 than males in Thetford Mines who ranked third in this analysis. I .: . Furthe,r analysis by age and sex has been attempted tOl: the cocnunities ot Rimouski and ThettordMines and the results appear in Table 5. Interpretation is difficult ,because of'the small number of persons involved in the -ege: groups in the two communities. It is of interest to note, however, that among Thetford males - '. I the bighest mortality rate is recorded' in males agted 25-34. In R1mouski males I the bighest rate is in the group 35 and older. Thetford females aged '25-34 have =0. "_ .. , the r~ehe~t rate in either ~e or female groups,. being 519.8 per 100,000, or four times the 'provincial rate for the .s~ agres. The rate in the corresponding age group I . - in Ril:1ouski feztales is 446.4 which is' nearly three times the Provincial rate in the . SamB age group., Tuberculosis also takes a high toll .in Rimouski females 35 and older Here the rate is tour times that of Provincial females ot the 8am:3 ages~ TABLE 5 Tuberculosis Deaths and Death Rates per 100,000 1940-1942 }iALES . '. AGE . All Ages 0-24 25-34 35 .j.. . Prov. of Quebec Deaths. P..ate 38SS 77.5, 1167 45.2 803 102.1 1918 .1l6.2 Rimousk1 Deaths Rate .17 . 5 2 10 171.9 93.3 114.4 360.9 Thetford Mines Deaths Rate . 36 190.1 13 121.3 10 342.9 1.3 245.0 '.' .... All ABes 0-24 25-34 35 +- Prov, of Quebec Dea.ths Rate 4019, 80.S 1614 62.7 1072 . 134.1 1333 83.1 FEHALES lUroouski Deaths Rate 32 (I 13 9 10 287.3 21109 446.4 334.7 Thetford Mlne~ Deaths Rate 43 223.9 18 162.S 16 S19.S' 9 178.1 . ENVIRONt-1ENTAL OBSERVATIONS AT THETFORD ' . ' Visual inspection of the mills of the three asbestos operators was made. Dust COWlts were ~de at all important working locations or these properties, am the results are given in a separate report. There was no opportunity to personallr observe home co~dit10ns) eating and living habits of the population, but this inro~tion'was repo~ed to us by, competent observers. I SeveraL conditions prevail in the mills which would ['avor the spread of pulmona17. tuberculosis. The workmen appear to be careles~ about spitting and other per~onal habitB. In order to keep warm in cold weather they huddle in groups in small wooden cabin-like e'nclosuras. These measure about 61 x 6'. They usually contain a bench or two and. .. chair~ with some heating facilities; a small tin can on the floor which is used t,or c1ga~tte butts, spitting, or left-over food. In one mill a tin dr~ cup bas been in use tor c.any years. It is obvious that, it there is an employee with tubercle bacilli in ,his sputum, these environmental conditions favor the spread ot tubercUlosis. It should ~e noted that in review of ~he death claims in the mines insured with t~ Company a d1!!erence in tuberculosis mortality was found. In Mine A between 19U"~ , , eight de,aths were due to tuberculosis with a rate of 2.8 per 1,060 employee-yeara. In , Mine B tor the corresponding period there were two tuberculosis deaths wi~h a rate of .. ' l.4. It was in Mine , A that the most conspicuous unsanitary practice, the common '. " drinkins cup, was found. Home living conditions ~re crowded and it is common practice tor children am adult.o ,\' .. 8 - "This is an important factor favoring the transmission of the disease--npt I ' because it promotes closer human contact but, by interfering with adequate rest, tbe individual1s resistance to infection is lowered. Poor eating habits and tood selection which prevail also contribute to the lowering of resistance to tuberculosis. I . 1 f These observations on environmental factors are admittedly superficial because ot . the brief tice available for inspection and observation. Nevertheless, because ot their probable "1.r.portance in creating and maintaining tuberculosis in the co.a:mun1ty" f~ber investigation .ot them would seem to be warranted. "" . DISCUSSIGN It is obvious that tuberculosis mortality is excessive in the town ot Thetford Mines. But 'there is no indication fro~ these data that occupation is a dominant fGctor because: 1)' the mortality is equally bad amoI18 females; 2) it is excessive I' in the, age group ur.der 24 where there is little 9r no industrial eXposure; 3) tuber- ' culosis is also a serious problem in Rimouski where there is no asbestos industry. . "' The age and sex distribution ot mortality from tuberculosis resembles the picture of tuberculosis in a heavily seed~d, susceptible population with a substan- tial proportion of the mortality . occurring in both sexes unde. r age 24 and the majority of deaths under age 350 There is no evidence, if ~sbestos dust is a factor, that it resembles free silica in its influence on tuberculosis mortality. Careful and ' ,thoroU.6h mort.ality studieslOamong granite cutters in the state of Vermont revealed that they are s~bject to an excessive frequency of deaths from pulmonary tuberculosis, not because of an exceptional risk ot contact infection, or because ot interior PP1sique, or because ot unfavorable housing conditions or.other sanitar,rdeticiencies. ( but pri.I::.a.rily because ot the occupational exposure. This same c~nclusion has been reached in ~very other study of workers who c6~tract silicosis. , :' Unfortunately we were unable to calculate expected deaths based on the Proviccial , i rates beC8:use the age groupings obtained tor Thetford Mines and Rimouslddid not cor~spond to the age group1n8s availabl~ in the census data tor the Province. For further itisight into the magnitude of the tuberculosis problem ' in these two I co~tiesI , ~t would be desirable no~ only to construct such expectancy tables, but to .1 ' carry out case-!indingstudie s in the se and similar communities in the Province of Quebec. - " CONCLUSION 1.. :Basad on current mortality data, tuberculosis in Thetford Kines, in conelro...r_as_t----to many co~unities in the Province as well as the Province as a whole, .has substantially increased. 2. Rimouski, a lumbering town, comparable to Thetford Mines in socio-economic conditionsl medical. and public health resources.. has a' high tuberculosis mortality co~parable to Thetford Mines o 3. Analysis of the tuberculosis mortality by age an$i sex in Thetford Mines, in the other comnities and in the Province shows that both males and females in Thetford succ~~b to the disease with approximately the same frequency. This is not the mortality picture seen where there is industrial exposure to tree silica 4. Admittedly our data is inadequate for final conclusions.. nevertheless ~her9 tro~ pe~ is.no indication this mortality study that demonstrates asbestos mining in Thetford Mines is the Cause of the high tuberculosis mortality~ S. Further mortality studies should be ~de to construct expectancy tables !~r' age and sex inThetford Mines, Ri.I:louski.. ana perhaps elsewhera in the Province." 6. Tuberculosis. case-findu{g surveys should be made both in Thetford Minas and co~parable co~unitiea ..-.. " ..... \ - 10 - 7. Health education concerning prevention of the disease is needed, as well as improved sanitation, particularly in the plants. George M. Wheatley, M.D. Assistant Medical Director Metropolitan Life Insurance CcmpaJ'lY' .Hr. R. J. Vane j Manager of Occupation Ratings, has- contributed to this ~rm1tted .~ ~tudy by valuable suggestions regarding the handling and interpretation . . ot the data as well as by making the statistical analysis. I.. ~ Dr. A. J. Lanza, Assistant HedicU Director, has va; generouslY us to use his unpublished data secured by Pedley in 1930 on asbestosis and . tuberculosis in miners of Thet!ord and Asbestos. .Dr. Lanza has also advised on the preparation o! the final 'report. Dr. N. L. Burnette, Assistant. Secretary, secured tor us the information on . the:socio-economic conditions of the selected communities. .' ' . . .' ...... REFERENCES M., I 1. Desmeules, R., Rousseau, L., Giroux, and Richard P. "Asbestosis and Pulmonary Tuberculosis". Laval medical, Vol. S, March, 1943. p.2l7. """t:--~ 2. DeSQ~ulesJ R., and Giroux, H. "Asbestosis and Pulmonary Tuberculosisn. Laval cedical. Vol. B, }larch 1943 __ p. 227. I. ~ f .;;. Lanza, A. J., McConnell, Willia:n J., and Fehnel, J. William. "Errecta 01' the Inhalation of. Asbestos Dust .on the Lungs 01' Asbestos Workers." Reprint 166.5, i'rO::1 the .Public Health Reports. Vol. 50, . No.1, ""January 4, 1-9-3-5.. . . 4 ..Donnelly, J. "Pulmonary Asbestosis: Incidence and Prognosis". Journal of Industrial Hygiene and Toxicology. Vol. 18, No.4, April 1936. . . '. .5. McPheeters, S. B. "Survey of a Group 01' EIr.~oyees Exposed to Asbestos Dust". Journal of Industrial Hygiene and Toxicology, Vol. 18, No.4, April 1936: 6 0 Lanza, A. J OJ and Pedley, Frank Go Unpub~ished data. . ' .. 7. Tuherculosis in II".dustr.Y.o Saranac Laboratory Symposium, 1941. Published bl' .the National. 'l'uberculosis Association., p. 199. 8. Pedley, Frank G. "Asbestosis".' Canadian Journal of Public Health, November ~ . Tuberculosis in Industry. Saranac Laboratory Symposium, illl. Published bl' the National Tuberculosis Association.. p.SO. . 10 Hoff~nJ Frederick L. The Problem of Dust Phthisis in the Granite Stone IndusttY. Bulletin of the U. S. Bureau 01' Labor StatistiCS, No. 293, May 1922. . .. I Q. V"A tv S~ bo v(); f\/ ~. (p ,;' NS(1-/~ . IVA~ SABO URI N, Q .C. I (' . , , . A.LDRED aUILDIN.O, MONTREAL. MEMO ThIs TuberculoslB-.Asbestosls 1944 Sarver c~ueted by ,~\ l ' MetropolltaA LUe (Dr. George Yfheatley then Assi&tant Medical ~ . Dl rector roo. At tohfe MtiemtrGe ptohUist aD~WyewInasNceovmmYournkie)amte1\1ghttobteheofoIfnfitecerersstato t~\:! I Quebec such as Workmen's CompfmsaUon BoartT, departmental hea<1S~ ClI1~ also to the members of the Pneumoconiosis Commlttee of the I Workmen' 8 CompenatiOD Bo3.r\1 and also to the then pulmonary i ~I rts In the Provlnce. . ..---.------- - The att.ae:\l~" copy was ma(fe out of the bastc rep of Dr. 'WheaUey 1Ihlch I have In my files. ~ ftU IV It\w..i-t-- 7"',I r . In connecUoa with ClUICer. tho same prejv.<ll.ce 11 I rampant now, as 100 know, whleh was rampant before 1944 as . ~--- Tuberculosis. The Metropolibn &UrVGy (ltspellet1 that prej~l =- At that t~e we also ha(J test eases con(fucte6 (the he~r1ngs b . OI1;J attenae4 by the lea(:1ng experts of the continent) to prove that COM tJ N1 fr: JJ asbestosla exposure (11(( DOt invite ~. B. . ~o ~rll;;' Plttaburg sanAesrtotooCkapnIcaecl'e- Inex~peos5u0re'8 3sbestoslnc14enee. th (Dr. Daniel Brao.n - his ~fl!.-lL.i..-60 was also publishea) whleh 8Un'ey'a conclusions. just as In the eo K6?~ /<f asbestoslB, conelOt'feCI that there 18 not seemingly any relaUoo&ulI betweea (J1lSt exposure .~(f easacer. . Dr. Braun (together wtth Dr. GregOlre, Professor Benttle of Cambrl(1ge, Professor Kushner of New York UDl'ler8tty -- aD expert tn the patholQgy of cancer tumors -- .is a member of the sctentlflc committee of our propose<! Institute tin<ler the c:halrmDclhlp of Dr. ":right. }.prU 29th, 1966. .1. s. IVAN. SA-SOURIS I l-<' c., AD~'OCATE (I MONTREAl., MEMO Thi s Tubercul osi s-Asbest osis 1944 Survey conduct ed by Met ropol i tan Lif e (Dr. George Wheat 1ey then Assi st ant Met'iical Di rect or of Metropol it an Llf e in New York) roi ght be of I nt erest to you.' At the time this study was communicated to the officers at Quebec such as Workmen's Compensat i on Board, depart ment al heads and al so to the members of t he Pneumoconiosis Committee of the Workmen's Compensation Board and also to the then pulmonary . ,'expert sin the Provi n c e . . The at t acheo copy was made out of t he basi c report of Dr. Wheat 1ey whi ch I have i Ii my fi 1es. . I n connect i on wi th Cancer, t ~e s,arne prej udice is rampant now, as you Imow, which was rampant bef ore 1944 as to Tuberculosis. The Metropol it an survey dispel 1ea that prej uoi ceo At that time we also haa test cases ~onoucted (the hearings being attenaea by the 1eaaingexpert s of the cont inent) to prove that asbestosis exposure did not iIivit e T. B. As to Cancer - exposure to asbestos incidence, the .Pittsburg survey took place in the 50's (Dr. Daniel Braun - his st uay was al so publ i shea) whi ch survey's concl usions, just as in 'the case of asbestosis, concludea that there is not seemingly any ,reI at ionship between dust exposure ana cancer. Dr. Braun (together with Dr. GregOire, Professor Beattie of Cambridge, Prof ess(j)r Kushner of New York University -- an expert in ~e pathalogy of cancer tumors --) is a member of the sci ent i1 c commi ttee of our proposea inst i tut e under the chai rmanship 9f Dr. Wright. ' April 29th, . 1.966 1. s. :::: ~.:-.:-.7.:;;'::.:::.~::'::'~'::'::::::;:::::::~:::::.~.;:;:.;.;.:,~:.::::::::::::::::::::::::::.':::.'::::.':::.7:.-:::::':'::::::::::::::::::.:':::::.::'.:'.:'.:',':::::::::':::":~'.':':.'::'.'::::::::::"':::.:::::::'::::::::::::::~-::7'.::::':.~'............................... ,..................................................... . ~::::::.::.:~:::::::::::::::::::::::::::::::::::::::::::::::::::::'.:::::::::::::::::-;:::::::::::::::::.....::.::::::::::::::::::::::::::::::'::::::::::::::... ' :. ".'::::::::::::::...:::::'::::::.::::.:::::::':::::::::::: ....~:. ':..".":::::::::::::::::::::::~:.:: :::~::::. ..... , .................. ::~. . nnbre 1947 .dra que Ie lent.ement. arulis que fa une surface' ,. MEDECINE INDUSTRIELLE TUBERCULOSE ET AMIANTOSE. connaUSClnc:es cu:tutllu sur I'assodaticm amiClnto-rubeTC'Uiose ,. Gnalyse de Ie mortcr1iti par tubtrculose a Tbeifcml-les-Mines, Qu'",. Canada, centr. minier d'omianta. Certains incidents r~~nts ont attire l'attention sur I... relation qui pourrait exister entre 14 tuberc:ulose et l'amiantose. De plus. Ie rait que cette.dernrere vrent d'~tre re<:onnue coxnme maladie industJ"ielle par Ie gouvernement de la provinc:e de Quebec a accru l'interlt mMieo-l.&gal du diagnostic ct de l'appr~tion des acteurs etiologiqucs, car les malades qui fODt de !'amiantose deviennent su;ets l indemnisation. L'kude histo-pathologique des poumons d'anciens employes dans l'in- dustrie de l'a.miante a montr~ 1.1. presence, che% Ie m~mc sujet, d'amiantose et de tuberculose (1 et 2). A Thetford-les-Mines, centre miniet d'amiante Ie plus considerable .au. Canada. Ie 'taux de mortali.te par tube..culose a a.PPl'oxi:mativement d.oubt~ durant <lea dernieres annl.-es, tandis que dans Ia provinc:e de Quebec en ;meral. iI a atmsiblemcnt dilnlnul!. Cette constatation 8. ~D.tribu6 objectivement .. cr~eJ' dans Qu~bec l'impJ:ession qu'il existe lme relation de ca.use 1 e{['et entre l'amiaJltose et la tubetculose, relation quiserait semblabII! .. c:elle df:j'a ~Qlidetnent etablie et g6n&-aletnent acc.:eptee qui exi1lte entre fa silicose et tuberculose. ~9) Vl. ~ ," ~\I. \'\,-\'1 .. ' , "", ;, " .'( :t: I' , I' .~ : I'j .", , , t ' OS/22/95 16:53 TX/RX NO.1824 P.OOl OJ/22/95." 'lrON~i.~;s:7;FA:x "10 US 7,lSS -.~ -~~""""""'" ~--- - - " 1090 LAVAL MiDrCAL Novembre 1941 Noven MaIheureusement, il DOUS a ete impossible de ca,leuIer les c morts probables buies 8'Uf Jell tau provinciaux, puce que Is groupes d'lg;e obtenus pour ThetfoN et Rlmouski ne cOlTe$po;daicDt pas 8.UX sroupea dAge que DOUS rournit Ie recenselllent de II. province. Pour rendre POAihIe UDe ~tude plua approfondie du probl~rne de fa tuberculose dans eel deux vilIes de Thetford et Rimoulki, il sembIera.it souhaita.ble de preparer, non seuIClIlcnt de semblables tableaux de probabilitea. mais aussi de r.ire dces enqu~teS de d6pistage dans Cd vUles et dans phweurs autres villes de II. province de Qu6bec. 7. et UD( usines I. O 2.0 CONCLUSIONS 3. L 1. D'apr~ les statiatiquel d{omo&1'aphiques, surtout celles des deep, Ia tuberculose .. Thetford-la-Mints, eontra~rement a ce qui lie produit dans plusieuts autres villa et dans la province en glmix-ai, a augmente substantiellement. 2. Rimouski. vUle dont l'industrie principale est Ie commerce du bois de consuuc:tU;n et qui joWt de conditions socials et economiquu., d'organmations mWk:ales at d'hYSUme resScmhlant A. celles de Thetford . ' Monne auui un taux ~eri de mortalite par tubercuIose. 3. L's.nalyse de la monaJitc par tllberc:ulose par groupes dtage et a par sex~ a Tbett"ord. dans les autres ",ilIea; et dadS la province. d~montre que la Crequence de 1a tuba-wlose est pcu prm 1& m~JDa c:hez lea hommes et les femmes. Toutes lea fois que Is poussiere de since devient un facteur de !Donalite, Ie tau~ de mortali1:.e change notablement. 4. Nons admettons que plusieuJ'II donnee. nons manquent pour nous permcttrc de conc:lurc de fa~n definitive i n~nmoins, dans c:ette ~tude, rien ne demontre qUe!: I'industrie de Iamiante ,oit Ie facteur ca~al a qui ponrrait expliquer Ie tau" hIeve de mortalid: par tuberculose qui existe Thetford. s. D'auues etudes d~mographiq\J.O. uevraient ~tre aites afin de pouvoir whlir I"incidence probable de la tubereuIolC suivant I'Age et Ie sexe a. Thetford-la-Mines. l. Rimollslci et ailleura da.ns la province. 6. Des campagnes de dlspistage devraient ~tre organisees 1 Thetford et dans d'alltres villea indu.triellea. 4. :c S. l\ 6. r 7. ') 8. J 9. : 10. 1 OS/22/95 16:53 TX/RX NO.1824 P.OI0 OS/22/95 U7 !me . de La de pro- :ieu1 \Cber -oupe .nUes ,ir de tasse. .verte ~tiona LVOns lBqui 1lIIiPs, :1lberr Dana s. soit Dloins uranu Lvor1se Novembq 1947 L"VAL MiDICAL 1089 qu'iI nuit au sommal et, indueetement- dimid.ue Ia resistance hldividuelle a 1. maladie. Une m.uvaise hysiane aJimentaire. assez l&lerale au eein de 180 popur.tiOIl ouvrlere. contribue aussi l dilninuer La rbsistanet: ala tuberculou. Ces obse.-vations d'~nonUe sociale 8OI1t evidemmcnt superficielles de A cause len courte durh. N~moUu. Ie facteur social joue dans I'etude de I.. tubetwlose un rille important et il 'Y aurait de nombreux a avantages pousser plus loin nne enquf:te de CO genre. DlSCt1SSJON a II est' evident que la mortalitf: par "tu.bcrcuIoae est trop 61ev6e Thetford. Cependant. il est diftici1e.. d'apres lea faits que 110\\S V~DOns son d'.um_er, de c:oDclure que Ie travail m~me un facteur aLus.tL1 domi- nant parce que 1& Inortalitf: est aussi etc. c:hu les femmes ; parce qu'cUe e$t trea friquente chez:les individU8 Aga de moins de 24 ans chez qui iI n'y a pas d'histoire de m.aladje prof:S8ionnelie et parce que a ou 1& tubcrcu.lo,Je constitue un probleDle aU88i s6rieux Rimouski il n'eUste pu d'industrie d'anUante ni aUCUDe ibdusuie JDil1i~re. La. diss~nJnation de Ja tuber(.ulose d~apm l'Age et Ie 5exe des individus morts de tuherculose, semble bien &trc ~lle qu.i ae voit dans une popula.tion fomment cont&mmH et particuJiirement sensible la. finfectioll. En efl'et, Dne forte proportion des d4cd IU'l"Viennent chez des slljets dell deux sexes qui p'ont pas encore 34 ans et Ia grande majorlte des d~ds arrivcnt avant I"Age de 35 aM. Il ne semble pu d'apr~ Ies faits rcleves, que 1& poussiere d'amiante inHuence autant que Is. silicc libre Ia rnortalit6 par tubereuJoae et Qu'elJe en ",it un {acteur CA\IS&l. Des fltudes serieuscs et e.pprofondies de la mortalite chez Jes taille\1I5 de granit. de l't-tat du Vermont ont r",,~l~ une friquc11.ee tr~ eIevee de la a. tuberc:uIose plllmonaire. non pas cause cl'une possibilidl exceptionnelle de contaMination plus massive; non pas 8. ca\l.l~ d'un etat physique inf6rieuJ' des employes, cle Iopments malsains ou d'autres conditioDs a hygieniq"esdefieicntes. mais bien cause dll m~ier m~me de (.es ouvriers. La m&me condusion s'est impo. ap~ toartes Js enquhes faites chez a les ouvriers expose. II. silice Jibre. I I J I : r , i' . ~ r\ .1 r~' l.j !\II,. ' 1-.. r.. r. ,I H:\ ".1 'I , OS/22/95 16:53 TX/RX NO.1824 P.009 1088 LAVAL MiDICAL Novembre 1941 Novem observ6 d&D8 toute Ia province de Quebec pou~ tous les sujets du mame Age. A RilQouski, Ie taw!: chez Ic:s emmC8 ayant 2S a. 34 au. est de qu'iJ nu l la. m, 446.4, soit trois fob 18 taux officiel pour la province de Qu6bec. La sein de 1iuherculCHIe eat aUlsi tris ripandue .. Riinoulki, cllez les femmes de Ala tu~ . 3S ILD.S ct plu,- et If: taux de 1& morbiditC par tuberc:\llose est dtez ceIla-ci, quatl'e foia plus l!leve que celui de toute I. pr.wince de Qu~c. eel a cause !'etude ". avantat CoNDITIONS HYGltNlQUES A THETFoaD ete La surveillance hYl:i~nique des Moulins de trois compagnics minN:res a etC ,aite. Des echantillons d'air on't preIeves 1 divers endroits des wsines e1i lea partJcuJes de poussiere y ont /rtf: comptees. Lea renseicne- U meau coneemanl l'hygiine alirnentaire,l'hygiate personnelle et l'hypae Thetfo I.,I.J~ de ('habitation now ont '" transmis par dea gens dipes de roi. Nous d'~null I'~ n'AvODS pas pu (aire nous-mf:me cette cnquMe. nant p r, . i II ~jste dans l'usinc pIu.leurs causes qui peuvcnt favoriser la pro- qu'elle ;"1 pagation de Ia 'tuhercuJose puImonaire. Les ouvriers sont pen souc:ieux chez q de leur hygi~ne personnelle 8t ptUlieurs ont m~me l'hahitude de erac:her III. tub 8ur Ie p1ancher. En Jaiver, pour se prot6ger contre Ie froid. On se groupe n'exist dans de petites cabines de bois ayant $ix pieds par six pieds, g&rnics Ll d'un petit poMe, d'un bane, d'une couple de chaises et d'un crachoir de in.divi( fortune. Da.ns Ie, moulin, les ouvriel8 boivent tous 8. III. mome 1;a8st. une p DaDS ~ conditions, if .emble evident qu'un cas de tuberc::u.lose ollverte l'infec devient unr,et da.nger de contamination. En et:udiant les reclamations dessu. lors du decet des o,uvrier. ayant une police d'assurance, nons avons des d~ con.tate dans Ie taw;: de mortaIite par tuberc:ulolSl!I, une d.ifI~enoo qui faits 1 serait en rapport avec IeB conditions bygieniques des dilierents moulins. A Ia mine A, de 1941 8. 1944. huit morts ont etc causl!es par III. tuber- libre J Des er cuIosc, ce qui donne un taux de 2.8 par 1,000 employt.annees. Dans granil III. mine S, pour la periode correspondantc, it n'y a eu que 2 morts, soit tuber. un taux de 1.4. La mine A avait des conditions hygii!niques moins de eo satisfaisante8. inf&i L. habitations sont; encornbdJls8 ct, assea: frequemment, lea enfantS hygic et lea adultea partagent Ie mbne lit. Cet etat de ch08CS anormal fa.vorUse la contagion, nOD seulement A cause de I.. promiscuitl:, me aUSIIi puce Lam Ies 01 OS/22/95 16:53 TX/RX NO.1824 P.008 ---;----. '05/U/9S J(011 18:S8PAJ: 410 885 7lSS -. 1087 Novembre 1947 I . l ;;; I ! I I .... "'! ~ Cl 1 - ~ .lt ~ ~ i! - -- ~ ~ .,., 9 "" = JOur ible. lSki. !leri pIIlt Ie aet6 lDS 10 dans :r une 1Il"tde ~en- IOuski. 1111. A sBeve e 'taWl: ... I 1 .. ;e 1 J .,.. I~; II ~ .. J s .... !. 1 (-i i .; 11 -j! ~ j:I" J -.~... '" ~ ~ "....."...:... 0} ~ ...-...... .... N ~ -- - J ~ .... $ ~U\ N S ~ 'CI ~ ! t; :l i -c~ .o.. ., : . :.- : . ; : : : . I j '! d "i. 1': ~ ~ e"'" ~... ~ ! m OS/22/95 16:53 TX/RX NO.1824 P.007 f \ 1086 LAVAL MiD1CAL Novernbte 1947 Novemb RimoU8ki qui est Ie' centre industriel l~ plus comparable, bien qu'a Rim01l8ki. l'industrie PJ"inc.ipale ~it Ie bois. et qu'a Thetford, ~ soit i' l"amiante (voir tableau 3). ' f.' ~.i TABLEAU" T4WC mOJfCfU" fh mortcdill, p.r .Jat " ~r fDu.t fa 4Iu dcl.lIS Ie pro.tll:e et Jan.les sept , emIT'" dlobu,lSJ40..4l PIlO~C. DB QUiaBC .. , , ...... Ittrotd-le.. Ca~la-M~d.ltinll .... , ........... , Sa. nt.-8yac:inthe .. , , ..... , , ... Salnw_n ... ,...................... Vf.1leyfteJd .......................... Cblcoudmi. . . . . . . . . ... M~ .................. mould ................... Hotn.JIIG 77.' '5.9 85.4 75.1 101.7 141,8 190.1 171.9 Fflfftm.1t SO.8 44.S 90.9 log.a 8!;.3 149.1 223.9 287.3 Le tableau 4 pous indique que trois des sept ville.s doisies pour etablir 1a comparaison ont un tau de mortali~ par tuberculaR sensible- .... mduernatnptl1u&spSme-ivoidqeu1.e94t;0e-l4u2i ,dIee ttoauuxtemlaoyperonvcihneczeldese fQemuembeesc.estAIeRpilmusoeulsekvie. et, aThetford, Ie tawc. durant )a pf:riode c.orrespondante, est aussi plus bleve chez lea femm~s que ehez les hommes. Ceux-ci occupent Ie troia~e rang dans cette analyse. Une analy.e 8uppl~Dlentaire par groupes d'A.ge et par sexe a. ~ a faitf: Rirnouski et l Thetford et .. foutt'li les resultats inscrits dans Ie tableau. S. A cause du petit nomb~ de personnes comprises 0&11S' chaque groupe d'~ pour ces deux ville., it est difIiciIe de donner une interpretation satisfaiaante des faits. Tout de m~rne. it est interessant de rCnlarquer qu'a. Thetford. Ie taux Ie plus 6leve chez. lea hommes, est en- a regiatre chez de. individus Ag6s de 25 34 ans, tandis que. l Rimoll.ki. Ie tal.1X Ie plus elev~ est ob5crv~ chez ceux qui ant 35 anll et plus. . A Thetford, lee remm~8 Apes de 25 a 34 ans Fourni.sent un taux pIu," .Mev' que celui des homme8: 5\9.8 pout 100,000, soit quatre foUs Ie taux ~j -...~.., .. ~ .S... ...tg.l ~ C t U'\ ~ E ~ "'~ J ~f-i , .., t;-O OS/22/95 16:53 TX/RX NO. 1824 P.006 'OStZZI4JS . - -- --- - lfO~ N -1-8-:~$-:$..op..--.U. _U_0_8_8_$_7"1$-$ 1 .- i. 2 ~ it&- le rd ut IlU ant cel; trir im.om- ;)ld~ : Ie. or- :ion. ques 'lAris :eurs sont a ell lIas; d-Ies- inth~ iseIn c'ect NOVenmre 1941 LAVAL Mi:nJlC""L lOSS - -+ + + ++ ++ ;t + 1 f II : ~ i~ : 11{ tfJ. .: ! : II :I - I:iO I ..I, 1 :~ I ./ OS/22/95 16:53 TX/RX NO.1B24 P.005 --"'~,---,.---. .. " ",'" ,'.1: OS/22/95 ,16:53 TX/RX NO.1824 P.004 '05/22/85 HON 16: 54 FAI410 685 7155 LAVAl. MtDICAL NovemhTe 1941 a Depllis II. paruuon de ce rapport de Pedley. il .'est produit Ull chan- pment tr~ appreciable entre les tawc de l'Ilort.\lJIte par tuberculose 1 Thetford-Ies-Min4:$ ~ lea tAU de Ja province de QuMlec. i.e tableau 2 indiq\l.e q\l.e Ie tau moyen de la province de Qo.ebec a dilllinue de 35% .i l"on tion e co at mpare 1a p&i leDBibiement ode 1940-42 la mAme ai 11a ncur pi S, riod tau c t 1926--28. au Cana d Cette a qu'a CO us JIstata- ~t&ts Unis. M&i.s 1. Thetford, p0\l.r lea periodes ~orrespondantes. uiste une augmentation de 80 p. cent. Or, Ie fait que" tuberculose soit l Thetford un probl~1D1I dominant, & fait naltre des h1pothbes SUI: Ie rille que peut avoir 1& poussi~re d'amiante dans Ia production d'une telle situation. Novel .. ~ .I,? bTUDa DJt LA 'MORTALlT6: PAR LA TT.JBBJl.CULOBE . I Si l'inhalation de la pOUS8i~ d'amiante peut J:HlIement acccntuer I I ou a.c::eeI6rer l'wolution de la tuberculose, l'on pent vraiM:mblablement . a s'&ttendre de trouver Thetford un plus gra.nd nombre de 1:uberculeax chez Jea homroes de 2..5 ans et plus, puisque la maieure partie de Cle$ indi",idua qui ne font pas partie de l'armN:, travaiUent dans l"indUM' de l'anJoiante. La rOle des conditiona sociales et economiqucs est im- portant dans l'~tude de: la tuberculOIllIl. Ce:st pourquoi, avant de com- parer Ice taux de la monalite par la tuherculosc dans \& ville de Thetford- Ies-Minet avec ceux d'autres' centres, il est n~5aire d'en etudier let conditione sociales fit economiques, Ies conditions hygi.C:niques, les Qr- ganismea dthygibc pubIfque et Ies caracteres raciaux de la popula.tion. Dublin fait rernarquer que lorsque Ies facteurs sociaux e1: economiques sont evidents, lcs tau,. de la morta1ite par tuberculose chu les maris comme chez leI 6po11Ses 50nt identiques i et quand ee lont Ies facteurs industriels qui pr6dominent, les ta.ux: standardises de Ja mortalii~ sont plus ~levCs chu les hommes que chez les femmes, Le Dr Paul Parrot, d~mographe de la province de Qu~bec, a eu I'amsbilite de nous fournir les &t.atistiques de mort&litC: par tubereulose. suiva\1t I'ige et Ie sexe, ge 1939 a 1943, pour 105 cites de Thetl'ord-les- Mines. Rimouski, Chicoutimi, Cap-de-Ia-M.o.deleine, Sain't-Hyacinthe, Saint-Jean, Valleyfic::ld, Ia province de Quebec et Ie Canada. Des sept ville, qlli ont f:te choisics a cause de nombreuscs rcssemblances. c'cst I OS/22/95 16:53 TX/RX NO.1824 P.004 - -- -- '05/221BS --:-- MON' .,......... 18: --.. --$3FAI .---.. :t.ez ceuz Gee. E't pas lla lstne de aient des J083 Novembre 1947 OJJSItJ\VATIONS llaCVBILUS AU CANADA Aueun rapport n'a. Me publi6 des etudes {&ite9 au Canada chez'ies 1a tuberculose ou de l'amiante au lujet de l'incidence de de l'amiante. Tout de tn~me, en 1930. ouvriers de l'amiantoae dans l'industrie edley et sea coIlabo"Ateura ont rait l'e:u,D\en c1inique et radiotogique ford-Ies-Mines et PdAesb1e9s5tosou(v6l)'.iersLedetabl'alemaiuan1t.deodnannesIelersescuiltthandtedeT: hceettte enqu~te. TABLEAU I Asbato.s rn ouvrier r ailIeur it trouva r&llliaate ndepous- NPOoIunh~re~d up~a'd~I1~p1q.yl:s. e.x.poa. tn,lsk. . .a..1.' "'.1\.NQDm1biraemd ee.ed.e, pcal'a' .mpJldau'nns1rd'a0el1a1et0;ltote.:. .. . .. Pourc:cnta~ des ca.$ 1-41 22 18 12.7 '483.4 24 44.4 .cen foyer Jete radio. ~.5% pre. 1n de ceux lutre c6t6. d'amiante ividus. iI y Apra cette xlifiai't pas a Un Beul cas de tubel'culosc en activite a et~ t.rouve parmi Ies 19.5 uoe fr~uence de tu- xa.mirlMs. M~me auiourd'hui. e'en aein d'un groupe induGttiel. puisqu'elJe p.ersonnes e bereulose tr~ sati$faisante: &\1 proximativement celie trouv" en 1940 apres enqu~te dan. rinseul cas de est ap dustric de la conf~ction_ Dan_ cette derniere industrie. un i les 165 individU$ examinl!. (7). tuberculose active estima a ete que Ie Jrouve parm tau~ de mortalite par tuherculosc. Thf:tord. taux Pedley (8) pour 1926, 1927 et 1928. pouvait Ie compan:r favorablement avec Ie de la province de QuBbec. 1+ TABLEAU 2 lea ouvrj~n est pas plus 1940-42 % cllan,nttmot UItries. Et ~ndrai' 1926-28 .1------ - I"inhalation ~ 78.6 -35 0" IfrtvdeiiUlfeerrenteAs TPhroevtficnten":ld.leesQ-LMl~bineca:.............. 112337..69 252.1 +80 III )J:e. , " , I II. I , OS/22/95 16:53 TX/RX NO.1824 P.003 1 Dr. McConnell Weltare Division Industrial Hea.lth Seation Re, 43-0-2 - lTohhentsfoornd'_WCione.,. West, ~uebec We issued this pollc)" in 1929, aDd to date .e have premium. or 133,000 agalAit Death cla1ma or ~28,500 and DiaabUiit,n. cthlaeimcsuraretn8t),,.0e0a0r,. thTebepreerlpllieurmieanc8JenOisunvtiQeriyto unfavorable $6,8)0 with Death clalma ot $11,000 and D1aabilit1 claims ot $1,000. An aDA1,.a1. at the calma ahows a preponderance . o.t lung disordera. The COllp&rq' i. eDPiad in the, manutacturin& ot albeatol, and .e teel that there qUB.r17ing and is a decided occupational hazard.her.. We .ould lik. to bave ,.ou or 1I:r. 'ehnel illlpect the plantI ot thi. cO.~1V' at 10ur convenience. Attached 1. a COPT ot tbe claia anal1al --------..... : .' 'I U. 11J:::-;upcrtlor Actuar1&l Divi.ion . Group Lit. " B~&l~ Sect~on /4671055 ......~;-:-=:=.;:...:..-=-- ...--. . ......-......- - {:.~; . ..... -. ..... '..~\'..:.z: ~ . . ." _ -.-.....- " . .. '.- ....-----.......... '.... :.,--- . . .!'RODUCED SlCiMtMs Dr. hicConoell, Welfare Division, Industrial Health Section Re: Johnson's CompaD7, Thetford ~iDes West, Quebec We cover the employees of the ~bove com?8D7 for group life insurance, and to date the claims amount to 93% of the ?remi~s. Several years ago the experience was unfavorable, and we referred the group to you because there was a substantial number of claims tor lung diseases. There has been an improvement in the experience in recent years and the coverage has shown a profit since 1935. In 1936 the question ot offering this.. compaa;r Accident & Health benefits was considered and we asked you to ~ake an inspection of the ?roperties. You reported that the employees were French Canadians acdlooked undernouriShed and that in your opinion the claim experience would not be very good. On the basis of this report, we decided not to offer Accident &Health coverage. Our representative bas again raised the question of Accident & Health covera,e and advises us that the comp&Q1 ha. appropriated a considerable SUIIl of moner for mine improvement.. Possib17 this .Ul 1m?rove the group as a risk tor group coverage. ~e would appreciate a further inspection of this company's properties and a report from you at your cOnTenience. The group is not large enough to justify the expenae ot a special trip for this inspection, but pOllibly you .ill bave lomlonl in the vic1ni~ loon and can have him make a report. In advising us .hether you con.ider th1.l coapaIl1 an acceptable risk far Accident & Health cOTerage, you will want to take into consideration that for this industry (asbestos minel) .e load our standard rates 40%. In other .ord., it' you think the cla~ rate rill. be le.. tba.D. 140% or the cla.1.a rate in a noc-hazardous induatrr, our ~~ rate should be adeqUAte. Of courle, the plan .e will offer .ill nOF0vld. benetits for occupational accidents. . I ~/ /.O?IL ~~ Ac - Group Lit 'Health Section r~@YS161~ ~ tOS/22/,pt.tiN18:U>.f~ .1.(I~SS 71:,\5 - - ...,...... -.~.-.~ ~.. ""'"!- ~ ........ ~. 1082 LAVAL MtDIC""L Novembr.l 1947 a LeI enquMes fane. chez lea ouvriers da.lUl'l'industrie de r ..miante ' n'ont pas d6montre que la tuberculoR lItait plus fdquente cbu ceux qui prhsentaient des lignu cliniqlle8 et r..diologiques daDlj8lltoa~. Et Lanza (3) c;onc1uait, en 19351 <au.e l'amiantoac n predispose pu k tubereulole. L'~ameD. medical de 126 employe. dans Itindustrie de I'amiante ..ux ttats-Unis a d'lI1ontr~ que 53.1% de ceux-ci avaie:nt des signes radioloe;iques d'amianto,e, et que' deu~ OUvhUS avaient one tuberculose en ...ctivne dont l'un emit allSsi amiantosique. S', a. En 1936, Donnelly (4) faisai~ l"examen radiologique de 191 ouv.riers de ItamULntc et dflpqtait 34.4% de cas d'amiantose, mais aueun ouvrier de ce dernier sroupe ne fwait une tubcrc:ufo.e active. Par ailIeurs" parmi tes cas qui ne presentaient allcuue image d'a.miantose. il trouva quatre ca8 de tubercuIo.e active, dont 2 travalllaient dans l"amia.nte depuis 6 et 10 ans. Alors. Donnelly conduait que l"inhalation de pou~ sime d'amiante peT n'6ttI,it pas de nature teveiller un ancien foyer de tllberculose. MePheeters (5), en 1936, pubIiait Ie rapport de son cnqu~e ntdiologique sur 210 ouV'riers de l'amiante dans lequel i1 dit que 2S.5% pr6sentaient des sipes radiologiqud d'amiantose. mnis qu'aucun de ceu qui 80uffraient d'amie.ntose n'etait tuberculeux. D'un autre c&te, 3 ouvriers apres 6, 9 et 10 ans d'exposition .. 1a poussiere d'amiante pre.entaient uneimage de tuben:ulose active. Chez 5 individus, II y avait aasociation d'une tuberculose guerie et d'amia.ntose. Apres ectte enquete McPheeters condus.it que Ie. tuberculose ne modifiait pas l'evolution de l'amiantosc_ En resumh, les enquetee raites aux ttats-Unis chez les ouvriets de l'amiallte indiquent que la fr6Quence de In tuberculose n'eat pas plus eIev~ dans l'indultrie de l'amiante que dans les autra industries. Et ro&ne plus, qu'it n'existe Aucun fait qui prouveralt que J'innaIatioD. prolongee de la poussi~rc de. l'amianw serait de nature i. reveiller ou l stimuler un processus, tubercweux. Conclusions totalement differentes de celles qui ont ete obtenues dans l'industrie de 1a silice libre. , , ouvr I'am Pedl de 1 Ashe NOli: Po,,: Nor. POll pel be: eS1 d'll tu PI P( de = J 1 OS/22/95 16:53 TX/RX NO.1824 P.002 \ --~ ) IVAN SABOURIN AD.OC"'~ . . I .;. -, MoHTftlAC.. J'1JJ1, 3Dt4, 1945. , ,, George. 15. Alal.tan V a~ley. laq., V.D., Qirelldent, Weltara, lletropo11 Lit. Inl-.t1'8l1ce Company, NEW YORK , N.Y. . U.S.A. 1:'1 . ',~ '4 .,-, Dear George, ~ t~ I beg to acknowledge reodp' ot ;yolU'a of ,18th inet. Content. haTe bttan, noted.. ork at I :haYe not I",ooel'ded ill thettont Jill1. ".ullmer a. the baT1nS yoang llthier: operaSor. thlra bad - eet- w lately made 10_ 4b.e.n, i which .et-up the,. 414 1n their not wish -tlbl10 X'.la'1on. to 411!Jhz'" tor tM rdingly uacnop'm6 iFngatSbUeJrIIJ:ISleO:Ur.-T iIerhaaTpePl1a%ntoer'JaDp8p4 rJe-caitallAtirTBeooUfT-imeyr aoco ett'o~. thi. I!W d. ot your.. Dr, I.a.ttZ& 1. meuina. lather BouTler morning. 'a ~. I and. h a , e a t . he w111 be xa-pZe'ztu. Uo,nf atht.ehe dwa7H.ykeesntde.r.da.at,.IDw1 ihtohtDe_ a:.. .,' D.t. Iat1 thf Doo,,",n el ..d, of the 4p 'lU,'bIC YorklDerl t .4ical lIIlpr...10Il on them. Hi. Board oon'tr1- yestaril bl.\1doa. prope~ iY m I .. a.ppt. aun o1at , l w111 _ by " pr he O I f. M 'to 410 b al . . "f.r7 xper ba te, l .ptul. Jitr., 111 " _be . 1'61"'\1'48 ~ blato.1 ..t.u~.H\llo.1. 1noidI110t. " "---.' .. ' ;'''!J:Wlk you,;:tOl' the oow . po1D,\ i. now of the letter tLll11 oleaze4 mitten ~:p . by Dr. ar~.. th1 '?t ' ..~ (-, .' ," peI'8onal,l'$garda. . i; _ S.3 ( ( \ i .. ,.~ -~tp. r c~ lJI eQ ..."~i " u .... t. .o.'.,..e-..'..n;, ~f'1 . . f-'1exX: -0 s: c. rIa :~ ~ t.~..!"t~S: ~ ~r~ ;J ... ~: _.:~ .... w' O....J0O ~ (I)"'" ..... I .. " c"". "II9I I..t.Xt ...C:..,,:' t6 .. 3" .e: ., ....... ;::: fI ~ . I''''!2~.~tf. o .... 4 .. t' ~ i .~.~.l..:.-1~ t ~~"It~.Cl rOI: (0- 1r i.' ."....... t.'Ii. ...r."'r1f1: ... "cu ..tor: !-::~r.t:.,p.. 1:1I::t:~~~.1l I: .... ltio...-II:"IIJ! t ~ ... ~~~ .S! .. ~... ~ .. or6r .-L " .o.... ~"h..ar tt " .. .... 0" ~J~r I ...,.:11 r. ... I' !.~:tc 0 "5 i ' " 0 I - [l , : : . . ... .. to c .. lr"' Z " ... .... ... -...... . ."., .. o Scc......... Srt! 'c.:. 1b.ICI"!C I .... (. ~ 4 I !;t.:t~,.;. lie .. or ... . C.I.r r". ;.;. .2. ., r. ~ ~ 'f :\ 1 ",,,~f;i ~:;:ti -I ,11 f . t,t...... So- 4 &.t' r~c f'! [$ ::,~ ~,:: ~ ~!5 !(.; ...i ' dl "toe: ;"1'. ... "'! E' t"o'.~.1.7 C;i~' i l~t: ..IiIa _ -.-, s !Er!nl ,g~ 5~(;'f r ... '~ ......... i . " - .. . -.- . . . . . .... ,-... ~~~~~....~..~ ~..:. =======-=-====---~ .~ _la. Jt q eboal4 alto ...... II t1heat.th&ocrJsiDac1Sta\tl.IeprUtJ_'O_a w!o1U1aoc.1,a8ut...D4 ri. .,.iDIt..l'rol'lW b 11 . 70 fabs..PtI.'hWdaJDt.thtoatli.e.., 111&1f'tw. iYthV. J Dr1.pPt\a1114t'oU'.J'.Ot1.lIr Ida .. .8at.W &U'.Ft.iUelaUotfIlt.tbbeathoirDi.tzoancal&altlloeaa1uUdl ,Da1e1pOarutlineDltr..ile6.tIa_, a.lk.S...D.Uc laia til.u..z. Jaa., r ~ &I'lltil,1D.tca:,t..i,.tniclaltl.. 1 wrot.. ol'W Dr. tar ,..,nit :~.."ttont m. l'ep-e t. death. of dWMtrbc1.&ol.0f1ll ) "ft t"b.U. ttuAbttr.c. uo1fo~.1.t1.tdo.la't4ll111a1... ftp CIIDl.7 iU,. .~ . .,tI.abtfrt.,tt.bto172'4SaIeU1Du4, I O1lMl pl"l4t arl .n .101a1S1a1. 1&! I7d" a iDtlT1dlallot ,.t able to aD oUtPhI,Zr "OtOollltahtUolDltptaa.t.wlOD..,_cUaplo~1lblt. Dot. 11 & 91%7 SaportADt. poiDt I.' to Dr. CInb........; ~ca1dDa1ter.to1toMr toJf f'taUwoUqall" til 6. ".001& rl, tou .upt.Ucla4%mtoowwJi0t1'IrDpI'1. a1u0U :mU'd1 all! let. Ua mGW ku who an that. JCN f,J'e.oOldq 40illl izl4utrial. J "'t .t.n.,a. Cl,abt'lt'o1lwl ibDee . toClt.beI". J at.tach & PCOIOUPIPoofrt.JIal,b,"J",lpl,ce1rIbi1RcJsiJ_IN.II.1.&,,b1t _ ttItao, trip &lace 1ft-ft, baeta,lthtotoCUa&4a J'bRe.-....,.1&O4cttoo_I"a1n6Ua'd. ,21,,11II.t.1_ . .t t.:brouP. %wo1l14 .... .... --- G...e..alr.lt' aI.t 1tlbo,.et.-1ltnr,.U.Dt.., . I,ltan '.. .., .f ~ . . .. ~.... . i. " n"-' "..n . "<' ,1".1'\\_'."" ..... '. - ,....., ~J\ , O : : "'!' " .. .' ", - , . .. y . ........" . ., fl' . ." IIf/f ~,.. JL LIJIZ&. IIIOI'IVI I'I ~;. j ; ; '"- -, -...- . ". . ., . to , .". j . . Am91e toilet facilities :are pro...ided e.nd ke~t cl~p.n. Drinkini ::t"ter- is SU7}lied. by bubbler type foul1t~,ins. Heated rooms or cE.bEnE.: e.re locr.ted on 3ach floor of the mill building. CONGLU~ I,)NS AND EECO:.j!Et1DATI~NS The concentrations of dust found at the time or this survey are much lower than those found in 1930. Thie me: be cue to the lI\ill l".ot op~!"~tiDg to cC9Ecity and improvement in the houEekeeping. Coverin~ of' conveyors is, no .C:~ubt, e. contributil".g fe.ctor also. iThsn the ::-:!?les --:.re td,;;en, the dnc.or.S' -::-er open ar~ the It is centr.:.tions. day roES clear~ recon:nended tlu.t efforts According to the Unite" be :nuie to further. rec.uce the (2) ~t-!:te3 PuiJlic He~lth ~~r.vice, cuc;t five con':';lillion !?=.rticl~s per cubic foot may be regerdec E..S the ~e..v..i:!lU!l ~.llo;.able concentrat:!.on: of e.sbestos oust. --- . There E..re e.ttached.repl."ints of t"'!:'o st'ldiee which rn~;r be of lntere!t in connection r.ith the hazard of aebestosduet: "Effectf: of the In.~t'.lEtion of Asbestos Cust :m the Lungs of Asbestos r:orke~5" "Asbestosis" .. -.----------------------.....-... . (~)TJ.~. P'~blic Het.lth ~er\'ice, Pub:'ic He~.1.th E'Jl~l- ~t-in-- N~-.-~-:- 1,--"A--,~-t- "J-~- r"- f --.-- f, ~t-Mto!is in t!"!.P. A!b .. -:tos Terlile Inf.u!trj-" J tS';:3. . , - . !IIii.1\ 'I iill I . lilill .- I"i'I.'ii:i i. Sample No. 1 2 J 4 " ~ Locntion Crusher. house, picking belts on prima17 Cl'usher Kin!! Mine ... Asbestos Corporation TbetfQm tinesl Quebecl Can. Date of Samplin~ Cu. Ft, A.ir Sam~led . Millions ofDust Particles per cu. ft. air Type of Dust 10/26/44 15.0 11.6 At~slbcestos Mill Bldg. 4th floor II 20.0 14.8 II (f[Jns f:lnd collectors) ~11. Bldg. 3rd floor II 15.0 17.0 II flb,'-== screening .. Mill Bldg. 2nd floor II 15.0 26.6 II rock zcreening JMill Blde. ~st floor II bE.gg!ng 15.0 18.1 Rem&.rks Test made on spoci~ run of small quantity of ro~. Cle~r dp.y. Not full pro- duction. Brickhuildi.n~, vrooden floors. Windows open. Clel"r tilY Wooden fioor, '!"indo\'fS open. UlN~r d:t:I. Concrete floor, window~ ~nd doors open. Clcer d~~~ ~ -,~- ;. I I I No che:nges have been mEde in the ~:.ill o~!!'r:;ti~!ls e"nce the f!:"s~ The s~mples: -::ere coll!cted end rne.1yzed o~, t.he method (lensed \ \ (1) 2.nd used by the United St?tes Public HeE'.lth ..Eervice. The follorlrig te.ble shot';s the concentrtions of dust found at the time ~fthis survey. -.... ....=0 . ~"IJ_.I"'\ . ..J_ ., .... . l r.. .... .. i ..; \ H"l"J A1H J.\ .\Q;.//.J ... ro .....fTl',.' .:: , (l)O.S. Public Heuth Service, P'Jblic Health B'.111~tin #117, Det~!"l!linrtio~ E!ld .C?:ltr?l or In:.u!tri?.l Dust, J.J. Bloomr1~lc. an::' J .M. :Ce.ll~v?119, 19~5. l .' .-:".. ,! ' : " .... ":~~ ~t ~-; --------------------,0-----~~-------------------------,-.,'o'~.,~~\..-,..G..-..-."...-.~[ \ .. ~: '\.;./ x:~~~ ~'. . "1 . r- ''.0-(':.-'' ," KI~q 1IDm 1,1.' i'" ........'- -1 ASBESTOS CORPORATION Thetford Mines, Ouebec, Q!n. * * *- A rechec~ survey of the dust con~itions in the mill of this com?e~y ii3S :'!1rde by the 'Industri!.'.l He~.lth ~ection of the Metro,olit~i1 tif-9 In~ur~nee CO:i1?s.ny on October 26, 1941~. A previous study h~ been ~~de in Junp., 1930 ",. INSTm,lTE OF OCCUPATIONAl. ~~O ENV1RONMENTAL H!AL1H MONTREAL, CANADA , -& ME ~ 0 R A H D 0 K :- !::l: tr. WheE. tle,. rR~~: lliss ?.eilly Attached are copies of the 3urveys m:!~e by :.ar. Fehn!l'l or the new mill in 1Larcb 1931. . ,f the Johnson' 5 The dust con- C~~pany ~ines and cent~ations found Mills in 1930 aDd were ~uch hi~her than the allowable c~ncentr~tio~ of fiv~ ~11lton by theD.S. Public Health Service for pdcouansrttcieci!nlletrs~astipboeeosrrtocinsubmtihcielflosco.rut s.ah1se~r~eodsuteaSpbhalritts:hnheeerndet wE.an:si athne imscprreoevnemin~gntdienpatrhte~ennetww~etrlel,sttihlel too JtII6I1052 ..........::!:? ............ high. Among six men physically ex~in,d two sh~wed first degree asbestosis but none of the men appeared to bave tuberculosis. The sanit&ry condItionscairnelethsesn,alsa!nat mwoe~re thraethemerplpooyeoer sanildl it w~s noticed spitting on t~e that rt.ileHreouwsai.nsgancounnduitsiuoanladeingreTeheotff')rd 1I&1nes .~ee also poor. The increased eince the war work causing a the mills correspon- dfalniondogaiinnecrseh~saveeinoeethneoppreordauticnti,on4ohfoduurssta, danadr. the lack oifncreidsetncmearopfrotduubceerc'auldoescirse.ased resistance among the employees whic~ may influence the It it is advisabolhensorn. 'sF.Cehonmepl acnalnparrorpaenrgteietso. go to Tbetford ~in~s to If possible, it might mbe~e.eallretcoheinckclusdureveay suorfvtehye oJf l1rl:>g conditions of ...,101e.s. ~ . ,.. . J --- ..... . \ . -! . /....: : .,~: ~ I ...... ,:" '.I : ::~ .: ,. . ., J -"-0-".-,' ......,, ...", ....... . , .. ... 0 ",. . rlU" I"" H, r"',.I. , ' - -...... ,-.1 1.1.10" .\,UM I,)U I\.-.., "'.\\' ,'U"" I1n' . .. I.' .. ' For. ~nJr.d 1~2~ltch, Dir.ctor or Diyll1o~ ~c~~ltl~~l X"llnl 2J JOT str..t JO'~!i, ILAn. I I 1:..". t 7~'Jr !tHoU ~r the l)t.~. 1 t..'\l~lI: it. 11 po II 1'0:'. U.tt tMI I .k.n.1_, k:S -':'1 ~'\,.. ..lH.t~cl AI 7Ulj rln.l O~ CllIU ~-.~:'ot~ I I to.ll 1n ~Ol' .hur.brlcat __ .b+.~, and n~t 1n tb~'t .~ .l~. it. Xt ~'" t~~~ rvl~.~c. of It in .. n who tria albestol ;1~ ~i:1~'I. '!'.!.~l .. , a.."Id o~ar JUt.u1l1 ot' t::!1: c.&.t.Y:', .!U a poWlr .... I or cog,., II 7~~ W\', tllc (let. thol t a un Jlw1 b, a CO:!;, tc:t ro.nt- ,c"obCltt 11 DOt .ort.." & bu:'ra~ 11:1 4.1~~011~ t.1'I11 t.)J>e ot t1la Un.!UlI ht ~I lo,e .%;.ri.~t. The coa;.t.tnt. r04nt~_aolo,llt, P2rt.lc~~!1 or 1! t. 11 I n lX,...rt, Till a,laolt. lnv~1ab17 read. lot ~~~loC' or 'I,. ~ u.. lila loA ann,. b.a.1~ Cl:l.llt. thl .~. ot IT. HutS. I null! w!Cut. to t.b.. , 1t \b.re 1.1 &!1.1 doubt. in tht Mtt.n, ~t. ~'7 ..n4 u.. .tlla toO )lo-..r SUjllon (or ..rlt1caUon ... l u t ,..~ .' .,-1.1._.-~-' "It.. Ik;~.~. .. -. \p LlLN.. ~. r.. . - J.' 'i .,~'1;,11.> t.,'I , ,I .' / " .. -. I ItU~\ lh\1!cliJ. D1r.c .f"I"'i PLAINTIFF'S J t- EXHIBIT ~ f !]12-=:..-.- . ...... j PLAINTIFF'S EXHIBIT ML-4'l'l~ 2/16/42 I have your letter of the 13th. I think it is possible that this man may have asbestosis. As you know, we find our cases of asbestosis in those who fabricate asbestos and not in those who mine it. We have found evidence of it in men who trim asbestos pipe moldings, shingles, and other material of this nature, with a power saw. Letter from A.J. Lanza, M.D. to Manfred Bo.ditch, Director ~ .~ Division of Occupational Bygiene/r1~j$A( ~e HL~1~ The Weekly Underwriter INDUSTRIAL DUST HAZARD (Coli/ililUd from Page 1417) . t~:-or, nc,:erthcless it is interesting to cb study in t.~c United Stl:es :il3:l tlut oi gr:lnlte t:::ti!l;. Long re=c~i%cd. as :a. (bn gerous t:":leie. it h:u been :ou::d lime a."d :lgain to ::Ike a i:':3;'Y toil in datils i:crn is ind:C3tcd b~ t::c h:;he:- ~:c:'!6!:t:1 :::= tuberculos:s ~,:l:OIlt;; c~;:oscti \\"o~\:c~s . ~ :1:;e 45. Aoo::: ail tl:3: (:In be !:aici c point irer:: th:.: ii:nitcd .-\::~cfic.:: ~i:: serve th3t they were quite unii.onnly high tubercuiosis. The :lmOllnt oi free silie. in ;\ncc co'nr=n~ cxrcric::c:. is tr.a: th~ t~ for copper .miners, gold and silver miners, the dust brclthed by these workers is very cuiosis coth r::tcs icr g:inciers. :nc:~ ;lei. and lead and zinc miners. The situ:a.tion as regards iron miners is interC$Ung beo.use it w~s thought for :a. long time that they had little or no e."Cposure to silica. More recent studies show th:a.t there 13rge. b :he yel:S 1925 to 1?36. lhe mor t:llity irern tuoercuiosis :a.mon; ;r:1nite :a.nd sandstone tutters was the highest recorded for :my of the 'groups of i."sured lives studied. There were more than 25 times u ishcrs. :L~t ~~:::crs .,,\"ho :1:: e,;;:ose-d !~ i.:- 0: = = or;:lnic Cl!.Sa, :nost which co ::et 0: a luge ~rce."ltage siiiea. :lre ::e: ?:!;::. having in ::1:::d the ccc::cm:c s~= of :'".t!~. workers as compared with Inc avenge o~ "is.:lctuallY:l modente degree oi siliea ha.urd which' . produccs silicosis in upw~rd$ of many deaths irom tuberculosis .:1.5 c."Cpec:ed: ",hcras in the e:uiier years, there were n!1ry poliCihoidc:r. L:~e. c~r::~~t. :&~ci ~:-~.. ci3i stone workers bci a quite ia\"on,;it twenty years. However., in bot';' insurance s'tudies there were too f~ daths from rcspintory tuberculosis to pe~it dc.6.nite quan- ne:r.rly ten times :a.s m:1ny daths as c.-cpected. b3sed on a small exposure. M:uble-':md limestone cutters did not show anything like as til:l.tive coodusions therefrom. high :a. ntio :a.s the ;ranite rod s:a.ndstone cut- A great many workers in mining occupa- ters. Thee were tt." datM where one was .tioD.$, it must be borne in mind, arc common expected in the years 1925 to 1936. 1.:a.borerS :among y.rhom we 'should c."Cpect a It on be but re;tc::ted th:lt there are so much' higher. mort:a.lity from tuberculosis few morality statistics ior occupations ex- than among st:LnclaRl ordinary policyholders. posed to dusts other than silica. Grinders From the limited data. av:a.i1.:a.ble for unsIcilled .. ' workers, from theSe studies it would appear '. . that the tuberculosis dath nte for this class ' oE-w. orkers runs between two and three times the.nte of standard ordinary business. Thus itis clear that even whenallowance is made of metals. most of whom for many yars lb' -_.. I lave eeo USU1g composition wh=.ls 10 pace oi L_ theholdd s:a.nI'dstIone wheels. :a.nd consequefntly rulve a :a. Itt e or no exposure to ree silio. e."C?Cricoccd a relatively low extn mort:::L!ity i rom tuberculosis in both studies. for: the impon:a.nt bctor of soci.2l-economic b:a.sed. however. on a small exposurc. An d:a.ss; the death ntes. for the mct:a.l miners interesting ~int to be noted here is that this a:r-cCoeaxlt.r~eimndey;ihiignh.d.ifferent sections of the eountry prcsent "an' . interesting contnst. Occupation also offers exposure 10' met:l.llic dust. It v.:ouJd appear that neither the dust from the ccn:nposition wneels tIC:- the met:::L! Among the bitUminous miners. exclusive of dust hu produced c."Cc:cssively high death the Pcnnsylnnia. miners, the mortality from ntcs' from tuberculosis. Buifers :lnd pol_ tuberculosis was' Over 1~. times that on ishers, a som~hat similar group, also ap- sb.ndard ordinary miners. a low ntio for peared to have a low extn morality from thistype of ,,!~rk~r. ~c.nnsylv:a.nia. miners. tuberculosis in the years 1915 to 1926. oi:'the' ~ther .hand. mo~t of whom were em- Cement and Lime Workers plo~ Ul .the anthraate fidel, had a very . higb"ntio-of: actual to expected deaths-,. Cement, lUDe,' and::lrtificial stoa~ worXel:S -well' over 300 per cent. Anthncite minc.pS, . we~e reported upon In both the.JOUlt Occu- as 'we have' stated, are exposed to an appre- pauon Study :a.nd .the O~tioaal Studr,. ci2.ble :amount of' silica dust, which accounts but ~e aumb~r of deaths from. tuberc:ulOStS for. their relatively unfavorable position. wu.1n each Instance less ~ the ~umber mortality. T::c '/ery hish ~::o icr =::~ 3nci limesto::e cutters, r.owever. :::3:r De !'.'\' scstive ot some u::toward inilu=:ce. D:. L. U. G:a.rc."ler a: Saranac Lake. ic:::-.d t.':.:! animals dus:e:i with r.-.arble dust by i;U tion. developed little :oction.. but be-....:: ternpor.lrilv more susce?tiblc to i:::=::= with tuberculosis. The increased sustr',.tiCii ity wu not rr.arked. The three occupations in which the: is eltposure to organic dust had frem t....o :a two and or.eiu.1i times the nu.-nbcr 0 i t::be:. culosis doths expected.. Even :a.llowins iet the economic position oi these groups lJ tomp:a.red -Mth ordin:a.ry policyholden go 0: erally, the mortality is high. I t is ci:::::::: to see in the H;ht ?resent c!iniol k::o,..j edge, how it is possible to :a.OC\lllt fo: r:: excess mort2lity on the score of d=te ::s the lungs =cd by S\!c.~ dust. Mortality findings. thc.". :a.rc still cot ::: complete ~~ony with diniol and laban tory findings. But irem a pnctiol cGt:' writing sw:Gpoint. it rr.ay be gid th".~. :.~ ::' only dust which of itself might s.:':'!:r~~~. the total cortality. by incrc:::uir'..; l:~ f.:.~: denc:e of tr:be:-tulosis. as to require at.. ''-':~1 premium c.u:g-e for liie i:uun::c:, is :n: siliCL \Ve have no moru1ity 0.1:1. for ubestos wor1a:rs but. it ::,.ay well be tbt c:. posure to asoestos ds:st in luge q\..ar:ti:!~ No dusty trade has received more creful reqUIred for sep:lnte tlbul:a.tlon. This fact f"\ in itself is signifiClDt. :a.l though it docs not ....,' ::::UncU,.u,~iter:;,~.. . '" .~,. :b:~:h=~~~:~.tcN~ Iagency m.an.agers . V theless. from the bets prcsCltcd.. in these. 1.. :.: ffi '. studies. it is quite evidc."t th:1t the tuber- .: . '. _ ~~.e-<) ~e men. culosis doth rate for' this occupational class Fo~~t.be first time. the "hole subjeet wu comparatively low. . .. ' ~ of s&lcguudioc life insura.tIce proceeds Three group~ of male wori(~rs e:tposed to ...!u.s beco reduced to fC:!i!!j. f!,rDl &D~ organic: dusts :a.re induded in the table- '. '. lU.bs~oec pracuc:&l ,pfpolr.l:~ a~~~ .:. _ 000 an upholsterers. cotton' mill operatives. :a.nd woolen mill opentivcs. Tn/: nnos for all :Safeguarding .; . ,. . UFE INSURANCE PROCEEDS B1' w: J. Wheeler and T. L Todd .. Here. . in simple la.sb.ioa. arc ex. "pWAc:d the desirablo; objectiTes to bo of thesc.classes run about 200-pe: cent, based on small exposures. It m~~t be a,d".'itted that these occupational mor~hty. stat\Su~ ~re: magT.e and do !lot pennJt of very dcnnlte conduslons regarding att&ined by s&lcguarding life insurance the effects of 'spcc:iAc: dusts. So far :lS they 'cstates: u well u apptoTed pnetic:&l go. they fuJly substa.otiate clinic:al and labon- '. pla.os of distribution 'of insurance pro- tory findiogs regarding the injurious ch:a.r- will also be iound tp produce a high ::::. tality , BAiDWIN'S: NEW YORK INSUR....NCE L\w ANNOTATED "Perpetual Re:tision Edition" is the one au.thoritv on New York Insurance l.:1,.... . It cor:!.t:iJts: The Insurance La... All miscellnneous statutes reiati.'ll!: to Insurance .- Exhaustive annotations Insuranc:e Department rulings oLuI.,.. ..,.. - , . ce. eId.s. .... .,'. 100_< .;.. .f \.. . ,........ _."....... 100 .....~t. eJw,.. _.. _.roi1aA".. "... .4 " -. _r.u. .u- ..101"",, -sol&la .... I_r ... par-.. u. "'- 41.. r.. _..., wi...A...hla........w..ia.JI.a.tullJ.......l.d.e.&. o It Iaak.M Ia.. ..."-",,ri... .. u ...~ 101. .... ..J.. .' actcr of silieab ducsutl. .Thfe death n. tes fro. m resplntory tu er OSIS or meo In occ:upa- tions where: there is a serious exposure to 51'1'lea dust arc so hI'gh .as to leave no foom for doubt th:lt silia. is the offending agency. . Contnry to eliniol and labontory find- Attorney General opinions "CommonSense" index Kept to date Price. $20' Inc:ludin~ .19<W Supplement ....up__.. 51.50 1'0."..14 '7!jl-tt mttitlv 'Q3:nllertDtittr' ""OJ 80 lrWdc.a Lane_ . '.' N.ew York iags. howe-Ier, the morcl1ity statistics. pre. sented by Collis and Yule. suggest th:1.t long cdcntinLu_e~d exposure '" to non-siliceous inorganic ust ~ an:U11unous effect on the lungs as tEue l!1lleeklv Qanbertr::<~~~ 80 Maiden Lan; l'ie,; ~':!';'''~1' ~'.~~;"~:", '8;' (940 'SURPLUS FUNDS ........ S309.7I7.567 . . 109.l92.<60 !:::.5J9.0~: 90.762.658 37.961.ll7 6'.902.795 Si.136.HJ 31.U2.202 lU55.'OZ lO.944.720 lO.3I4.i67 2S.l8l.923 )luN.1 . ~l .. t u a l . 27.050.79' 19.37'.230 19.010.80l Co. 01 V.... 16.956.930 Natl. T""' .. 1S.533.2H Gener"l ....23.687 )(......1 ......... 13.020.,98 Con....1 l.iC 11.34'.151 UCc, h ... .. 11.599.738 Ufe. V.... .. 11.224.492 :3. ='uion.1i l.Uc .\: ..'C: .. 2-'. Lincoln ~.1hon.11 2S. EquIUDI. LiCc. h .... 25. 5Ia Mu.u.1 ... ~7. P~ocnu: llutu.i ... 23. Southwestern Lilc . 29. ~ns. . .City Lii...... lO. Fid.lity ~!utu.1 .... l I. 1cif.rson S.t~ncl~!". . . . 32. ia.nkcr. lone. _.cu. Jl. P.ciflc ~lUN.1 . J.c. NorUswtllcrn Xalional ll. C...rdi.." WI.. l6. Rdiancc Lilc. 1.... , . Cre.. Southern .... l3. llonumenul Lii.. 19. Home Lile. N. \'.. .. 40. Occidental. C.lil.. .. .. 41. WI. '" C.u..alty ..... . 42. Continen.aI. Ill. 4l. Centrol LiC.. h ...... 47:J.&. Columbian NalionJ' 4;. A"".i. ~(utud .... 46... Calif. W.stcm ~ ....s. Pro.ident LiCe & ....cco 48. ~(UN:U Trust ...... . :0,4; 1.;;0 ~.?H.16; :I.: 77 .60~ 3.6H.JSI '.SH.962 '.SIO.OOO 205.95< . 46&.1l9 G.300.000 ;.71j9.1~9 1.67l.916 3.IH.9IS 5.269.'l9 j.HI.6?G '.'S3.020 1.;69.13< '.lOO.635 '.152.03' 4.0:7.235 l.?22.H3 l.S7S.BI l.129.065 l.112.79' 3.1?5.000 l.~Sl.SiG 3.2SI.713 I~. Wub. ::-:.. ion.1 ... 5,J. ~(inncsot.\ .\lu:u~1 51. Sun Lii .. llci. ....... 32. CciliAmous ~UN.I, 0 .. Sl. Ohio ~.1UOn21 ;4. Cuaranlee ~hn:,uJ .. , 53. llidl.ad ll ...ual 56. Amer. United. Inc!. 57. ~orth Amer. Rc:u.sur. 3S. C:unmonw'c2I1n 59. Western Laic. lIon.... 60. Home B.nenci.1 . $".. 61. Continenul A:ntt. G2. lhu. n.n~ .. ~l. Pilot Lii ~. Co ..... 6~. P.n.Ame..un wCe 65. Cencrai ,Amerlon . 66. Old Lin.. Wi s........ 667a.. B.ltimore Li I. Ohio 5t..e Liie...... ';? Presbyter.2n llin. iO. AIIi.nce l.iie .... ::. il. Buks"ir. Lii...... .. 7:!. FU1ners $: D.2.nkus 73. Business ~l,n ).10.. . 7~. ~ew World Wi...... . J.~SJ.3Jl ~.066.'0; 3.015.99' 2.70S.393 ~.~~:z.i~ l ... J/~.OI.& :!.SiO.lU ~.500.000 2.' 1l.9G1 ~.33l.$~S 2.350.000 2.lU.4JS 2.311.iI2 2.29l.I?6 2.2S5.9i6 2~,u.S2" 2.::c".",,~ 2.211.2iS 2.IS'.iil 1.07 '.617 1.363.97\ 1.S;9.775 I.S40.91! 1.334.66S 1.508.949 1.199.790 i:.;:. AI::.et. ::~,m':ll. i:..... ;'G. COlom,31 L.:'c: ...... Inl!usul31 L. !.. 1:'. G~. ~S. Prott1:t.,~ l;,ic: .. AiL .. . ,,? Cou:u.--v L.:;C........ .. SO-'mcnun :iut:.cu:.: ... . .::.:0.... . SI. Indunauoi.. L,i... .. Sl."r:UC2DIC [.;it ...... . 31. l'.ul Rev,,. L,i.... ~:. r-ran~hr. !....:.:. :.:..... . S;. C." ...I Loi. 56. lin.on Laoor Ld .. S;. O,c::on llutUll ..... . 53. ~[Gn2rch L:ic. ):.:.ss.. .. wi. . ..... S9. Lo~al P:oac:1\'c . ~ 90. Sout:1und I) 1. ~~uon~l Retcr'/e ?2. IllinoIS BJ.n~trs ... 9J. Voluntccr .lU:C ?.l....\tb.nuc LHt. V1.. .. ?S. Gi ..rd ufe. ?:....... 9(~ Gre~c ..'n,cr. TexIs ?7. Uniled Life .\: .\e:... "5. ~onhcr" Laic ..... 99. )'bs~ i"ro!c'!:IIYC too. Luchcu.tl. ){UEUll 1417 INDUSTRIAL DUST HAZARD (COlltilllUd frolllPagt 1413) culosis,. is considerably higher than among persons in the higher income groups. The 'scl~tion of cert3in kinds of work by the less 159.8 and 1~.2. Eut the sU::U:-.:lr/ ri,..:::s conccal interesting c!-~'Ulges with agl!. .J.. glance at the figures (shown on Table 4 oi r.r.rdy seen now aad the dinial picture robust workers is reAected in the high mor- their study), shows that in the Silica Group dunged with the .progress of dust con- t:llity f rom tuberculosis oi men in other the ratio of morality to the normal. thcu?;h mc:asures. The' trend is tovnrds a !:i';'Ies:~led incidence of' new cases of silicosis. im,nr<>v~,."t depends upon the main- ollings. R3ci:ll and n:ltionality groups te.:ld to enter certain occupations. wilh the result Ihat the pccuiiar susceptibility or relative I;rcater than unity even in Ihe lowest :I:;~ group. rapidly incrcases :IS :It;e 3dva:lces. In the Non-silica Group, the compantive r::or- oi constant vigilance in deteeting un:;,-SUSPCCI:ed h:lz3rds :lnd in supcrvisin~ the 'been efficiencv of dwt control methods ailer they 'have put into eflCl:t. It cannot be ~'C- Jie(ted that this iml'rovc:ment ",ill be reAected immunitv 10 tuberculosis of these slocks, colors Ii;c mortality picture of men in such occu(lalions. These arc but a iew oi th~ lIIany circumstances for whid\ :llIowance must be m:lde before condusions c:LJ\ be tality is :lctually bdow nonnal up to :lge 35 : it rises just above r.orm:,j ir. the io\lowi"lt :t:;e group: bitt as :1ges o\'er 015. it is ce=:- spicuously above norrn:lL" . The facts reg:Irdin" tuberculosis \<'ere :-:ot in insurance mortality until a considerable drawn:ls to whether a particular dwt is or published. in this report icr each of the si;( per:od of time h;u elapsed. ..... ______ --is not the responsible a!;I!.'lt in the hi~h mor- silica occup:a.tional d:lSscs included in the .The eondusion seems \Va~ranted f~o!". t31ity found 3mong men in a dusty tradc:. study. We have:, however. determined by c'.inial and laborator/ experience, tlren. that . Unfortunately there is, for. the United reference to the report of the Registrar Go- the only dusts whid1 of thonsdves misht St:ltes. no considerable body of mortality eral, Ihat e3eh of the ~ilk:l occupations had have sufficient effect on the mortality of slatistics sufficienlly detailed to permit oi over twice:' the I!."<pected number oi ce:lths. workers exposed to them, so .erat :IS to re- c:v:IlU4ling sep3r.ltdy some of cven Ihe: most The c:."Ctr.lordin:lry hi!:h r:ltio of 1.150 ~r an extra. pruniunl c1urge for liIe in- important. conditions aiIecting the mortility Cl:lt wu rccnrded for tin and copper m:'-:e:-s. are silia and possibly, asbestos, of men. in. specific occupations. Perhaps the while sandstone ma~ns. c-.:tters. and dressers nee men natur.llly will tum to best st:ltistiCll demonstration of the effect of had :a. ntio of 441 per cent. On the: other statistics for' connrmation of:a. different. types of dwt on morta1ity from hand., only the limestone m:1sons. C-.l:ters. ::.:-.d :a.t ri.riancC'with the common be'- 'tubCreulosis is supplied. .by two' British au- held. that e:tposure to all kinds of . thoritie~. Dr. Edg-ar'L Collis and G. Ud'ney dressers ot the five occ..tnatioas ccnside:e::i in the non-silic:l J;:rOUIl ~:thibitcd a hi;:h :-a::o. productive of a. high incidence of . Yule. These authors selected for study, 191 per et.-:t. :'''''nir:tlt<>r-v tuberculosis. To .thelayma.n it (rom the oCcupations reP!Jrted upon in the Like the English tin :lnd copper mir.ers reasotnble to suppose t1ut the .Reg-istnr:.General .0 Eng-Wtd 2.Dd Wales'. . 'Ammon' metal miners .3re exposed 10 :1:' breathing he experiences when report on OCCUf1:lti=l Mortality covui:lg- serious silica ha.nrd ar.d h3ve an' inordir.:lte . '. Lo large' quantities of dust ewt the yc:-:us 1921-192.3; two groul'S of occu~- mortality from rcspir:l:orj' tuberc-.:losis as W2y aliect his health, and th:l.t filling tions-one I!.,,<posed to silia dust. and the will be seen by reierence to 13ble 1. In this lungs 'with foreign partides m'wt have .other to nonsilica incrganic dust. Tne: t:lble :Ire l>ivcn the ntios oi actual to e::'t- effects on than. The writings of !;roups were so chosen that e:leh had. as far p~c:ed deaths irom tubcrtttiosis ior a n::.-::.- students of occuPational rr.ortality 'as possible. the sime amount of dwt c:."C- ber of occupations e.-.:posed 10 dust and re- have serv-ed to strengthen this be- -posure. physical effort, exposure to heat or to ported upon. in the Joint Occupation Stue:,. all such statistics. show the 1f'~:-41iOrt:Ulty from respiratory tuberculosis a.'1long ift::..../O~kelrs exposed to a wide V2riety of dusts above: the average for all workers weather. or any underground environment. P:lrt of the authors' comment on the rUuits as regards ~espiratory tuberculosis is quoted: "For all ases (20.to 65) the comparative 0: 1928. and in the Occ:Jr~tional Su:dv. 193i. both published bv the Actu:lrial S~ie:" America and the' Association of Life I~sur ance Medici Directors. In the ~riod 1915- in the study. But. when these figare refined so hor as is practicable to mortality figure (this fiSUre is defined as the number oi de:nhs thllt would have occurred 1926. the number oi deaths irom rcspir::.tcrl tuberculosis. among meal miners ~s ove'r allowance for. factors other than dwt, in the Standard Population at the ratcs rul- eight times the number c,"<pcctc:ci on the basis may inAuence: the' mort:t.lity from ing in the occupation) of the Silica Groul' of dcath ntes by ages prc\'2.iling among "tuberculosis of men emplo'yed in these occu- is no less than 5922 :against 163.5 for the stand:lrd ordinary lives in the same years. pUions. the irnpOrnnce of many. dwts as St:1ndard Population, i. e.. the mort:t.lit'l is In the latter study cO\'ering the years 1925 .causative factors becomes less evident. 'more than' three and a h:lll times the normal. IC 19~6. the ratios were cven higher-over 11 'There is a surprisingly large number of other than dust,. anyone of which For the' Non-silica' Group, the Compara.live Mortality Figure. alt~ough :letually slightly lime~ as' many doths were recorded for metal miners as were c:qlCctcd on the basis .rrt2.y be responsible ior the high mortality higher th:ln nortn:ll. :It first sight hartily oi de3th rates amon!: st::.nri:trd livcs in these '(rom tuberculosis .a!"ong men in dusty trades. I~me dusty occupations are carried 00 by 'mcn r~ruited irom the lower income d:lsscs. .scems to diner significntly from the normal: nor would one's judgment be much alic:d:ed if, instead of '113kint; eomp:lrisell with the years. . \Vhile the actual numhcr oi .doths lor ~:ld1 SI:1'3r3tl: l1let:l1 minin!! ebss w:1S r:t:~~~ 'unO"g whom it is now known that :lp2.rt ~'l:tirely from c:."<posure to a specific OCCUI'.tiona.! h.:uard. the: death r:lte from tuber- St3ndard Popul:lcion. one Iud us~d ti-:e 'Soci:ll Groups III :lnd IV. Cor which the respcetive Comparative Mortality Figures :Ire 0: small in both investi~tion5. and conseQue"tl;1 the: ratios arc subject :0 a large: margin (Conlinr",d on Pagl 1420) 1940 1413 men~1 :mi:nais nor co workmC::l e.."tposed to these dusts show any clinic:ll symptoms or :lscestosis. out most oi the ::lI:ai ClStS have been cOIZ1\1lic:lIcd by other ciise:ase SIIe..' as :!:eu~h C:lS:! wiii be 5e::I occsion:ail:~ ::::;.: I'rec~d 10:;. ::ll:li :c:~~:n:ltion witr-out ::::c::- X-r:ay appearances S\lS!;cstive oi silicosis. Silic.ates (:lncer :lI1d di:!octes so th:!t the elo:tent:o which thc Jsbcstosis WlS reSponsible for de:a:h is not clear. tic!'!. ::::xposure to :::cx:e~:e :a:::e::::ts Ot siEo. dl:st where: the: p:lr::::: counts :l.re 1:'1 excess A considc:r:able: number of silic.:atc:. dusts The p3tholo~ :1I:d Xr:ay :lppe:ar:l.'1ce oi 0: ten million dOl:s not occ:ur frec:ue::tly :I: have been studied and their effects upon experimml:l~ animals. both by inh:al.ation and :lsbestosis arc entirely diiierent from silicosis :and in the 3bsence of ~ definite history oi tr.e ,resent time. tr.ol:::n it is oniv in thei:!s: few ye:ars th:at siiia il:dustri~s haOle e..':.- injection. noted. They produce: little: or no expOSure o\'er ::t. consicier:lble: period oi tir:le d::wored to cope with thelr dust ;lreble:n :a:.d raction in the: body tissues and what little: to :ubestos dust. t.>:e diagnosis is ciiiicuit. A ene::tively reduce :.':e: :!mount. S::cn e..~ rc::action some: of them do produce docs not teld to progress. A.'l exception should be noted here' reprding :asbestos. whic:h is con- gre:!t dal of success h3S be:e..'l :atl:ained in controlling dusts in the: pl~nts where asbestos is i:abrioted so th:a: it is not likely th~t :as- pcsure:s produce ce:::nite:lr disC3se in :;::~ .::;;ht or ten to ;went~ or more ~'~rs, ::1 ;:re- portion to tr.e :ac::::!1 ql::lntity oi dust. T::e sidered scp.anuc:ly. bestosis will evcl" become :an important in- i"ddenee of tube:et:iosis is hiS?! :a..,d oi t.':ose Nor is oc:cup.ation:al exposure to silic:atc: dustri~1 disc::ue. as far as the number of who die: of tr-eir puimomry condition. i3 pe:- dusts accompanied by ~ny such c1inic:a1 pic- c:lses is concerned. - _ce..'lt arc tubercuiol:s. ture oi disability and death as is. found in The scarc:ity or c1iniol d3t3 on :uDc:stosis It is also possible to rind de!il'ees of silica silica duSt e..'Cposures. The Public: Holth makes the pros:nosis doubtful. We: h3\'e h:ld exposure which. whiie produci.'l; de:;nite siii- Service studied some talc: mineS in 1935. a sm:all group of cases under observ:ation for cosis evident on X-r:ays. will ::ot ;lrodl:ce dis- Only 66 men. were e:tposcd:- Tuberculosis :about ten yc::ars and. some of these show a :abilit~, or dc::atit in :an lI\'er:lge wor;";n~ ii:e- morbidity and mort:uity rates were very high definite but slow progression.:as far :as can tir::c. Mort:alitv statisties 3re n(ll broko . in the county where the mines were lOe:Ited be judged from the X-ray films. However, down b)- indust~ to an e.."Ctent sumcelt to : .:a1\Cl the dust e.'CpOsure was: exceedingly Se- wh~t the outcome m:ay be rem:ains to be scen. ::::Lice available dci1nite fi;ures by degrce oi .:. vue, running into hundreds of millions of These men :are all working and showing 110 exposure.. \Ve must rely then on the clinical - partideS. Eight men show~ advanced pneu- . signs of :any dis:ability. results obtained in industri~1 investigations moconiosis but tuberculosis was also present in most of them. It is conceivable th:at e..,,- Silicosis which are conc:lusive enough for those industries studied. Our own impression is :h:1t posure to trem~dous qu:antities oi :lily min- It rn:1y be s:aid that there is a very general. e\'en where the silica Il:lurd is of a r.:iid er:al dust, regardless of silica content, might :accord :unong the lading investig:ators and _ type. the incidence oi tuberculosis wiil be so overwhelm: the lungs that they could not resc::arcn authorities in the opinions :and con- hisher th:an the :aver:l;e. It has been st~ted de:u with the innding substance.. I nita- clusions presented in the international con- th:l.t where siiica dust cont:l.ins c:austic alk~lics lion. in6ammation. and probably infection ferences on silicosis. Such differences of :aiso, the ~ction of the silica is intensiiied. would follow with dis:lbility in proportion. opinion u .may be e..'Cpressc:d.!:om time to - "ery considerably. The evidence hel"e is Such isolated insbnces do not invalidate the time do not seriously anect the general r:leager Other substances apparcr.tly have: conclusions Sbted in the previous paragraph. Asbestos :agreement on the basic bctors affcc:tin-s the c:ause, incidencc, effects, :and prognosis oi silicosis. some inhibiting dec:t upon the action of ~i1ic:a. :lffecting !he p:a:hologic:al :as wcil as the clinical picture.. Asbestos is the only dust 0 f combined The effect of silica upon the lungs depalds silica. which is known to cause a ddini te on the nature and extent of e.."Cposurc:. Th.at Prognosis . :'=~'. pulmonary fibrosis which may result in dis- is to s:ay, upon the qu:anuty:of dust in the The prognosis is :air ior a siiicotic whose .}::-:::", ~bility and death. ~{ost of the asbestos bb- air breathed. by worlcmc:n, the amount of free lungs are not e..'Ctc:nsi..,ely d.:Lmaged :lnd who '." - ricated in the United Sbtes c:omes jrom the or uncombined siliea in the dust. the size is free of infection. Such persons have :l.'l .. mines. in Quebec.. Asbestosis, however, i!- of the dust particles, th" .presence of other inc::easc:d. su.sceptibiiity to infection :ar.d if 1I0t' found. among ascatos iil1.iien. most oL subst2nces ill the dust. which may modify brought into intim:ue c:mtact with a case m;;P5 whdm work: quunes or pit; 1101' the actioa of silica. and the length of time of tuherc:uJosis arc: very apt to become tube:-- amen; men cn~ged In muung ~r:atiOns or dur:ation of c:cposure. The individu:al c:Ilous also. TI:e outlook for the tuberc:ulo- affisanbetos whcrcb! ment an IS prepared for ship- himself must also be coosidered. Previously siiicotic is poor. )I.any c:ases :are esSeltiallv :a ed, but UIlong: worlccg in existing disease of the lungs, espcc:Wly a chronic and m~y live for years. Others sho";' fabrioting plants. Only rcc:ently has :ll1 ex- - tubercle infcctioa. will inllucnce his rc::action .. r:1pid. progression :a.ad die in irom one to two , pluattioh bedl CllEt ed fof this anomaly_ It to inhaled silica.. There may be other phases years- .uta' their in:c:tion becomeS active.. would appear th:at not only. is asbestos an of susceptibility :about which we know little The importlnce oi tuberculous in:ectien' e.."'tccption in that it differs from other sili- or nothing but in the m:ain. it may be stated :l.mong persons e.."<poscQ to silica dust brings cate dusts in its :ability to cause' structur:al th:l.t individu~l suse:e,tibility to the ~ction of u, a very important u::derwriti.'l~ consider:a- ch=gc:s in the lungs but its action appears to silica dust is :an aCXluired rather th:m a con- tion. th:at is, where the worker in a siEca be mechanical :lIld not c1iemical like the ~c- gcrut:U condition. , occup:ation is in contact in his home with :l.~ tion of silica. If asbestos is crushed to nne particles, it will not c:ause asbCstOJIS an $Xpcrimen...1 aniMds Hor will asbestos produce any tc:aa:!ofl dsewhcte Chid U1 the lungs. If its :rr;tion .. e. c hi ate nature of silica. the effcc:t would be more pronounced with smaller particle sizes. Consequently, Gardner concludes that the relatively.long spicules of ~s:' be5tos produce their effcc:t because the lungs are never at rcst and the cODStantmOVClllClt provokes the fibrous reaction. Like silicosis, asbestosis develops' slowly, prc:scnting the ch.aracteristic .symptom of shortness of brc::ath. The lIumber of c:ases oi asbe5tosis. that have come: to autopsy is sm1l1 but there arc several eases on rcc:ord in which death .was due entircly to the as. bestos :lIld not to ~ny associated infcc:tion or other condition: There docs not seem to be any .pr=o~.~~ tendency to tubcrC'.J.Iosis in In industry we lind different types of silica hazards. The severity of a silica h.aurd is estimated on the :amount. of dust in the air and this is expressed. in millions oi p~rtides per cubic foot The particles counted. arc those under ten niicrons .in size, though the present opinion is th:at it is the p~rticle. between one-hal f ~ mieron ~nd three microns th:at is mostly responsible for Qusing the disc::ase.. Exposure to excessive quantities of pure silica dust, that is. where the dust count is in the hbdreds of milliolU of particles per cubic foot, is now rare.. Isol:ated instances may be found ~s. in the case of a sand- bl:aster improperly protected. Such exposure 'produces :1 severe type of silicosis in upwards of five years, e',en Sooner in e..'Ctreme cases. With such e..'Cte..'1Sive silic:a dUnge to the ~u~gs! tubercle infection is :almost in~~blc:, open c:ase of tubercclosis_ The question is ir~uendr :asked whe~e: men who h:ad worked in silica dust ~t c::e time but l:ater cn:angc:d to ~ job in whk.' there was no exposure to silica might be considered. stand:ard risks for life insurance if they passed the usual insurance physical c...amination. \Vhile there are no insurance st~tisties 10 prove the point one way or t.'1e oth~l'. there is every rason to believe tr.at :l group of such r.:e.'l will not give a stand~rd mortality. The usu~l type of physic:al e:t...inin:ltion will not detect silicosis. Tne only way to be sure is to secure X-rays oi the lungs of such ~ppJionts ~nd have the..":'l interpreted by some one: who h:as specializcQ in reading films oi this kind. _ Silicosis is gr:lduall~' comin~ under control. . The aggnr.vated cases seen twenty years a:;o .~ (Conlin,,~J on Pa9~ .1~~7) ". '- .. 1412 M- .on"th'lyLife SJ2f2- .~ '. C7'\. . e Weeicly UnderwriTer Insurance Department JUNE 8. l!HO .Und~rwriting Asp~cts of the Industrial ,. .' Dust Hazard "- By A. J. L.:i'nla, M.D.; Assistant Medieal Director, and R. J. Vane, Statistieal Bureau, 0,tions . . .... : !'Ae!:opolitan' Life . , -Address Before Medil:al Seclion 0; A ",n;ean Lift COllvtnlion. Colorado Spri"!Jr, Colo.,JI/I~ 6 UR knowledge of h'~ih huuds reo sulting from exposure to Various ,kinds of dust'in industri:a.l :occupais baSed, on .observation and clinical wool, silk. supr,a;ur, starch, wood. tobacco, and leather. It is true that some occupations in which is involved e,:'Cposure to organic dusts m:lni- quality. Their lungs bcco pismClted ir= CO:lI dust, but they do n t devclop a tnIe fibrosis. For anthracite minen, the pitr"..n is quite different a:l4 the re:lSon is that ~ studies of workmen exposed to these dusts, and upon noting .the' results of the action of these same dusts' upon experimental,animals. fest a tuberculosis mortality .rate higher. tlun the average.. Formerly, it was thought that this undue prevalence oi tuberculosis thracite mining includes c.:'Cposure not oai:r' to coal dust but a1~ to silica. Disabliq miner's asthma was shown by the Uni:.e:i The former method goes bade for centuries was due to the occupational dusts but the "and our earliest 'conceptions of the hannful dust studies of .rece:lt ycars have demon- \ . . ' properties of dust ,were hued. on fint lund . :stra.ted that, mosdy, org:lnic particles :ue too . obsena.tion. . .. " large to pcoetnte' to the' pulmonary, tissue = . States Public Health Sen-ice sU:dv oi 1935 to be a. type oi silicosis. 10 'whici; the' :lnthraco-silicosis is properly applied. A.::c- . r:lCitc sc::uns ~re oitcn found in country rod: Ma.ny oi these conceptions were erroneous. It is only iii the past twenty. years that a.ny- thing like :l comprehensive knowledge of dust dise:a.ses bas been attained-=-due first to the perfection of the'X-hay as :L mems of and when they do, they are absorbed without producing any speciac inlla.mmatory reaction. Nods much credence given nowadays to the idea that organic: dun' particles eonvc:;- tuberele IncilU, to the lunp ~nd thus, cause which contains a considerable 'amount of free silia a.nd. :lS in other silica dust a-' posures. the Ge\"clopment of pulmo~ fibnlsis was :ound to.be: proportionate to tU amount of silica in the eoal dust ami t.:'.e diagnosis, and the development of succ.c.ssful Iabon.tory technique.. for conducting tests on experimcnt2l anbuals. . , .. ~ .:. '.' ~ Now we Iuve arrived at -a point where in- -tensive studies, both c1inical.:lnd experi- tuberculosis. M~tallic'Dusts Here the situation is not unlike that oi orga.nic dusts. The prevalence of pulmona.ry disease 'among workers in certain occupa- length of e..'Cposure.. The incidence oi tuber- culosis among anthracite miners is very hi~ . Qinical.pulmoaary taberculosis was iound in.. 15 per 'CClt of those with early :ln~' silicosis and in 43 per cent ot'those with znental, conducted in this: country a.od in other countries, Iuve resulted in a crystalization of our ideas.. In the E."\glish speaking tions exposed to :ne:a.llic dusts gave' rise to the theory that metallic dust wa.s a fruitful source of tuberculosis. Such dise2ses as advanced a.nthraco-si1icosis. Service upwards of, twenty to twent)'-five yean was a.ssodated with a. tuberculosis rate oi 14 per Cd world, the outstanding c.ontributions to our "grinder's rot" were recognized c1inic:illI" ..among rc!:ular mincrs :lnd 37 per CelI a:r.:::g knowledge line come from the South long before the en. of modern di.agnosis a.nd those with a. numbc:r oi yean a.s roclc work-, African ..Institute for Medical Resean:h~ a.nd laboratory TCSesrc..'t. Metallic ll:lrticlcs in ers. Animal e!cperimentation. with both the Miner's Phthisis Prevention Committee the form of fwues may. eause such reactions bituminous and anthracite coal dust, i.:e in.Johannesburg: from various official agen- as zinc chills or brass founder's ague, which irom associated silic::::l. produced no s~_oic cies in E."\gl:lnd and Austra.!ia.. in Ontario,. are more in the nature of an 'allergic reac. reaction. Canada. and in this country, especi.:lJly the tion. The: pulmonary disease which :aiiUcts N onSiliceous Minerals United States Public: Hea.lth ,Service, the United States' Bureau. of Mines, and the ,Saranac Labon.tory. . ' ':, ' : .' " ,. In pres~ting this discussion 'ot' industrial dusts, their cffects on worlanen' exposed to grinders and, buffers is silicosis and not in any way a result of exposure to metallic dust. Meb.llic: dust particles are mosdy large an.d heavy (that is, comparatively speaking). consequently do not penetrate to tne 111.,,\;:". There is no C',ide:nce th:lt non.siliceous m~erals produce a.ny pulmoaary disease. Gardner, at the Saranac Laboratory, tested ' upon animals such substances a.s dian:ond, aluminum oxide. rutile, marble.. gypsum, p .. them, :lnd the bearing that this subjec:t has in many,instances. :Lnd when they do thcy are lena. chalcopyrite.. iron sulphide. zinc sul- on life insurance underytriting, we" have at. either absorbed or 're:nain fixed and inert in phate, fiuorite, ::nd dolomite.. The sulpblCes tCDlptedtO 'sw:runarue what should be the the tissues. Frcm':ln underwriting sta.nd- and dolomite proved toxic: but this affect is iosura.nce a.ttitUde,baseii on th'c present state of our Icoowledgc.. Brieliy. the prescot con- cePt regarding'industrial dust 'hazards' is 'as f~lIows: OrF.ic: dusts, of which the dust: a.risinJ...in teXtile operations is a.n .CC!wple, '!hubs do not cause :lnY'3pcd1!e pWiiiona.ry disease.. no duuaI nor, lXperlftimti1 evi- .de:nce to the contrary. COlI, wltic:& i~r- garu"C'itIbScmCC; is considered in connection with mincra.! dus,lS:. O~ic: dusts at. ~es may cause :In allerglc re::lctlon :lnd also Irrlta~ point then, the haurd ofmeta.! dust is the outside of our present discussion. N on-silicehazard of, such silica dust as ~ay be a.sso- .ous minerals proved inactive in :lnimals uxi dated with it. Coal F~r nuny' years there has been a belie! that o:!al miners had less. tuberculosis than . the average for ~ge, earners and, on the there is no clinical evidence oi spccmc dis. cue a.mong worken c.'Cposed to this type oi dust. .. Arti.'icial Abrasives Experiments with artificial :lbnsivu other hand, miner's asthma has been recog- demonstrated the incorrectness oi nrlier nized as a.n occupational disease of coal ideas that dust caused injury to the 1u,"\!3, miners. Here again. recent studies have . proportionate to the hardness and sharpness' clarilied the sitU:ltion to a considerable' e:c- of 'the particles. Artificial :lbrasives. ~re, lion of thc upper air passages. They do not cause protracted. disability nor d""th. In tent. Bitwnmous or soit coal miners do not have :lmong the hardest substances known. Ne:t.'lu silicon carbide nor aluminum oxide proOutcd this classifieat.ion may ..be. .included cotton, an occuptional pneumoconiosis of a disabling :lny fcaction resembling silicosis in e;l;~eri- 1'"i;; . ! -:P~. L;EAXIHNITBIIFTF'S' :i 5c&11. 6 J IV I ....... , .~ 0": :"",.,_ :.11'\1 O~ '~'.I'. ~._ ...~::: -:-: ::'::::: :=::~HT LA,.,. ITI.F. :.: .... COOF' .' '. ~'i i '. '-! e ... 1 - . ., . ~.?o o~ i . ~ ..... " I ~ tlh"Ouv,7J"I"O\C J..SPIC':'S. Dl.'S1' RAZAJ.:> I , .~ , , ' the ume pb)'lic.iu, t.blllt wu bpOuIble to c.ome to any ~e~nHe ~ 'elusion and say, -this zn.1n ~ 01 ube.stosis," .ben his' prmous dlubility CC1t.mc.:Ues showtd tlat he ha.d myoardiili or hi,: blood pn:s.sure or Ql)t.cr Of djlbtte.s ~ palmon&r) .tybcrt'QI~ .... '. .' The pathology and XflY &flj)t1.nD~ 01 .ubestosis &:c ct.irt1y ~rrcrcnt Irom ,niCMis Ind In ~ abstnce 01 & de.finh..e binory of e:r;. posu~ 'O\'-i/ a ~o~duabJe pea:lol i . . . diffieul1.f.~ r~t t 01 S\lCCUS has ~ell attailled in OlD- run; dusu Ul the planu ...!:z::e asbe:toJ is Ilbriated so t.h.tt it is . ot likely that asbestosis 1r'I1l ever btc.orne an imporu..nt i."lGwt.~.l.l u.. a..~e," as far u the Zlumbci d ClStS is concUTIed. ' to '! IIlI 0:.11 es the prC'pcs.ll doubtful.\\'t baH bad I sm:l ,r~ oE Q!es lJllde: obstrntic!l for about tcn )'UT'S - there 1Tue i~nllJy, I think, J()me sixty odd mCl ' ill t.bil ,roup llld ie'still l:.an 6fty oC them wbere ....e a.:l ret It the1n - anc! some of a.est sl:or I dcnnitt but J,)o,.. prol:TC3.SioD as !ar as CI.ll ~ judjtf'1i Irom t~c Xay fUrru. H01rtver, ....hll the Otrtcoee !XUy be Jcr.uins to be ~:.. nts( l:lU ue all ....or~n' l..~d ~ow ~ 1i~.s of az:y dis.l!l.ility. . In the t:\e~lime tbt r!:lr.:s h.:vt btt:I cle z.ned up so tht tbe:u me~ are not C':Tp01ed n:)'~' to bordir~1e qlll~titi~ oC U~lOS C::l~. JD It is dilJicult to uy 'W~.:t n;uJd have ~t: ,:1lc: prO;rt.!l oC ~ei: dae.u.: had Lhcir ....orkin' Ctlrld:..i:>JU re.m.tintd :1le u.:e.. SILlCOSlS 11 It nuy be J,1i~ tlut tbt~ Is & vcy lenertl ac::ord L":'IOnt tbt " .,il(. rudjn~ inve:ni,lton l.Dd rtSU~ Jutbo:itiu b the c~i~i:lr.J L"ld C:::::l- " cJUsiOIlS pruented It th.t izlLt.n1llio:u..l.Cl:)niuCI:t:s 0Jl s.i:!icosi1.... (John- .. .J ,:- . I ..i; , " ~disffber~rn;c.C...l.\:o;C-.':ostp,-i:r2J9o3n0;.LSClfr:1.lny"1h, ~A~'Uy~.Sul..sudd{Sr5ot:-:?ltct-i:n~bte:t-o, 1ti9mJe!Jd:lSun2o1t . " ,~ " s.triO'U sly J rrret t.bt ,eMT1.l J ~mmt on t.he buic fa cton ~Ieci::, !.. .. .... .. , -:. .t :. the aUK, iDcldu~. eJ/etU, c:J pro~osis of Jilic..ni1. The efi'rct of J,11io tr?011 ~t l1Jnp d~d.s 0%1 tbe l'Uh:rt lnd nltn, of u~re.. 'Tllt is to .uY, V?O:l the qU1.1ltity of ch:st in the l' air bl~tbed by ,.orlmt.n, the unounl 01 Iree O! ~n.:orr.bint'd %llia . inlhe Just, the 1iu of the dwt particles. the prC1UlCt of oUleT' s:ub- ,~nm Us l1lct'dust wbich mar lnodiIy tr.t actioll cl 111io, ~~ lbe .A.. ltn~th oC time or dutltiotl of l:r;>Osure.. 'IDe indhid\:z.l hir:utl! mus~ -1 aht> ~ considered. r:t,io\a!: aistint d!~:.lt of the JunS1. t);n-C.llly ~ m . oj a tuLcrclt inrettion, .... innur~e his r~ction to inhJled J,1uc.. There m.:Iy be O~t1' plu.srs ot suJ.:t;>:.1l,nty lbout ,,bic.h lTC l.;n')V' little CT " - .... ". \: ' .. .. ' ,u -.-- -- . tmnt.n. tvlU..r~fN.- O-Asrr.cn. DUST IfA1.ARD .. d,,,t Jlltllrlr' or one to two ~"d l\.t('f mIcron, In th"I, '''~'''I dlamtltt, t'I;,1 IhM~ rmllrlri h~rl no physical duuct,.,hllc.s In the ordlnuy srl1S~ In "t.ich ""t oppl, IJ.rm. Arlil1chl lItu:uivu .rt :lhmn~ Ihe h:udut lult1hnC'('I IInotTf1. Ntlll," lilic~ c",blde nor .Iumlnum odele rr~ duCt,1 :any rr:'lclilln fcsrlnhlinr: sll!co,li lit ur~r'~nl:al InlmJls nor do .. 1rnll;rnrn upu\t'lllo IIlc:\t dltsl~ ~'-'n' any cllnlc:.l symplnms or X-uy .pfltlunU', sur:r:rstlve of silIcosIs. , , . I ' Sn_TCATES A con,lelrultle numbt:f nr ~ilklle .I,nt, hnt h<-tn .tudfrd and It' I',dr rUecls "pon t:lpcrlnW"nl:l1 lnlm:\I,. Loth tlY IlIhlbllon and InJec. lion. nnlrll. Thty rnoclucc1illle no tt':\cllnn In III(' Lod1 II!nut' Ind ..Iut lilll(' rl':I('II(,n ~me n' lht.n IJo Jlr".llIct dOt's hOI I,.n<f 10 pf"f.T,.~t. An fUt'l'llnn l'ollollltJ be nnlttl hc~ rel!.1tc.llnr: Isbt~lll!. ",lclch Is con. si"rrrd srp.ul.rly. Nnr Is oc("plllnn~1 (wJlMtI~,I. lIi1fr.'t dush IICctltn(Un'Ct' hy '"'Y . such cllnlnl rirllHt of cli~,hilily ~I dr:1.h u b fOllnel In SIllCI au,l ~'posur"- 'fI,t' .tuhlic IIr:\!I" $tontce !'hlliint ~me 1:'IIc ",'nr~ In 19J5. Onl1 66 mrn ""rrt "II~(,II. 1'"krc uln<ls tnnfl,I,III,. ami morla~ily 0' t:llrs "rte "rry 1111:h In 1M cnunt=, -lIrre' the mlnr, w('re JO<:llrd and tht ,11151 f'\pt'~tJrl! w:n f'1C'N'tlin;:lr ~\~tt'. rnnnlnt: Jnln hun,lrr,l, tnilliuns nl rlrliclN. F:1J:hl nw-n ,.fw",.nl :1111':1n('('I1 rnMlmlXnnlcr.-h bill 11I"C'Irltl~l~ "':IS nlQ) prr~rnl In tr<"'1 of Ihl""I. II I, cnllrtlYlhle Ih.t f'llC-.lft' Itt trrmrn,'illlt f]lIllnllllu .1 any mln,.,.1 .IIIS'. rrr.:UrIl~, 01 l'ili(:\.enllirnl. n1i,:111 lin oYrrwhrlm "Ir 111"1:1 Ih:11 I"C1 couM nol rlr~1 ~illt .he In":I,lIn/: 11I11~1".t('e. Julllllnn, Innlmmllllnn. lind prCl!J:\J.!y InrC'(IIOI1 w"uld I"Jln" "ilh dis.,IHlil~ In rrOfIOfIl'ln. Such holalrd 'lId:1ncU do nol Innlkb.e tht ronc'uslons ,bltll In Ihe rr('Vlo", . rlltl~rlph. ASDESro~ Ashf1.o, Is Iht' only dll!1 (If C'Omblnt'C1 .IIIC2 -ll/ch I, inown 10 CIU.!l.! elrfinlle ptllmon:1fY Ii!ltosls "hlrh f1I.,y '~IIII In dl~1I11i11ly and clt:1lh. I.rt tnt" m:lke Ihll (lOlnt cI"u, \\'htn we .:tlk 01 sillrosis nod Iltt' Irr!'s of' rI~51 ",~t procillce ~lIi('ns/~, lTt mrlln tJusis Ih:tl conllin :oilic:I In a ',rt' or "ncnmh/nr,1 ~1;1lt. ~IOJ. Wllrn ",e ,ilic:. " In ,Ill' Jar '" nl ~i1irnn eft' I,ill~ (r MJ;!nM/u", I'lIIn Ie nr /ron !lIic~ Ie ''':11 1s'\II ),:11 "'r mt':tn b,' cnm"',....' ,lIirl. The cocnltlnr<f ~lIic:lle "nr 'III~". In t k\\'r JII~I mef'lilont,J, do not prnctllCt' Jlulmonuy dis r,'~r. "i.h ('nr "crpllnn. lOll ,/ul I'nf t:tCt'r1htl b 1I~~!ln~, "h/rh I, li",,. II I" ,Ir"'",,, nl:ttlll'"illm silirllr n,h'urt, ",lIt. II fr.," In II. ~'011 til ,I,r r,om .~"rf(OJ l,ll,';c;1((,1 In IIot' U/lllr,1 ~1l't1 comf" '''e ",Inct In ,--.:!" ....... . ......... . ... ... 1 '. ,. . J. LMOZA, ..i.D. a ~. J. VANr. A. , C' "'l_ " '. It, .' I , I A)IH'Slo-s p:u.lcks. btl",. enl,,'" ~", .10 nnt I,roclllce :In.,. ('Uret I I.ln t./H'tlmtnlal ""'m~ls. F ..rlhrrrnnre. rnu c:\n (lfoclllrt' Il ~ili(nlic .,rrJcli,,". I"t' I~Inl Iillccllc ",willIe. In /In)' (lrr.:1n h~' InJr(lin~ prt, punt ~lIlca. \',1\1 cart r;ct IIIiCl~I~ nr lIce liver nr nr I hr ~l'lrtn or r"- I t'1.\cwhelt'. nllt you c:lnnol rru,llItf' lin)' ft,ullnn I" :tnlnc:t/s ,,;11t 'i .~hc~lU1 IIn}"t'lhtre flrtrt In Iht' lun~. lind .hcn onl}' U Y"llr liel,., 1ft !lIIrr,cknl1, .1:'Ir.,-. Con~'llIc"II~. r.:t"IJler cnnclll,lrs IhJI ti,e rrl;tllvtly 1(101: splclllt'S or '''0010' proclllce I"tir ('rr('('1 l)f'c:llI~e I/It' lunc~ '.rl' ntvrr at rrst and the [o",I:\nl mtJvrmrnl provnhs .he lil"ous tt':tcllon. , I llh .1"cn~I,sbe,losI. d~Iops II""ly, flrtsrnllrl~ tl,e ehat:c- .rrlsllc symp'nm 01 atuKlnt'ss ollnUlh. The numhrr or u!tc, of :ashes 'osls Ih"l h:ave CfJrnC 10 lIulop', I, ,m:\lI.but Ihrre :u(' !'c"rl;,1 OS" .II on ftto,d In "lIlch dt'3lh "33 due tnllrd,. to ,I'e ~ht"II)S and not 10 I any .~iJlrd Inlcd/nn or otht'r [onelilinl1. Theft' dar, not Hcm 10 be In,. pronou;,rcd ICOIirn<y to lullf'rrulc.slt In 1I~"r~ln~I,. Lilt mcsl o. Ihe ':'IIJI (:l~' hlye (,tcn cvmplicolrd hy olhrr cli,t:1st' such ~, I "",I canetr dbl)('lrs JO thlt the tilent 10 ..,hl(h Ihe IIst)(',lo,i. ,.,u IC"IO;ull,lc ror dealh Is nol c1r:tr. 'rn:ll1c rnlhN' tJlh:lu~llye 11uc1r r,..,., ~t':'IU .~ 01 111 Ihr y./' Insurance cefllficalrs Il:a. I (ould lind In ...hlch .ullt'slns 'u~ $:Ivrn lIS tile c:tu~t of dl:.lh 10(1 Ihen lo/lu,,"ed Uf' Ihe preY/ou, I.!storr fir Iht~e J'tf'oflle IIfll' r.ol their f'lnliC'RI c('tll"(:lI('I ..,hrl' Ihey ...rre all ,1IJ',i:iI~. \If" Til,. .fbr.nn\lt ~"'tn "" :he tJlu/,illly Ctr,l(ic:1lC'J ",,,:cll~ ~., II d,.,,10 "II,. ...I.w, '~ilh II., dl'Cno,1I ~'.v<n .\'" ,,,Ufo'll", by :> ,"" Ii '" I- . "" "t' ;.:J ..'.. ..~,t ' . .' ; ,,~', i L PROCEEDINGS OFniE "'TIiIRnETH ANNUAL MEETING OFnu: MEDI,.CAL SECTION , mnu MERICAN LIFE} CONVENTION' , ) :a1. ~ .L.. ,\. ' ... . .." . . . ,~ p. :.i !'I , .;J :; ; . :. .... ~ 1.... 1940 OFFICERS MEDICAL SECTION ' . , I I CMi:ma'l-Ol.. A. J. RCIlISSON, Mdic.:lJ Director. Connecticut GenenJ Uf( Insurance CoV'pan Hanford. Connttticut. - ~- "'.nnan-DL Vl. 1. BUt'X1010, Mtdial :. :.. ," , " .. . ,', /' P i LI u1 i,.-. . --: ,i Dire:to:. COmmon....t2lth Life Insurance Com- pany. Louil\'ilIc, Kcnr.zcJ.:l'_., Sc.cracry-D~ It FI BntI, lv' edical DirectOr, National Ure &. Acciocr)t I:uunr.ce Com;:anr. NuhvilJc. . TcnnClS~: McmZ,rr of l3o::rd of M~~t":1--rh.;T. H. Dto:roN, MtdicaJ Director. Minnuocl Mutull Ufe Insur- anc.c Company, S:.. F;lUl.. }.{innesou.. . ProDriarrntf~frilti-'-F:=-:'...i.zna!~Db'f"e ~IA"~u~:'~Jn~(~~GOoN. o.f Meodial Canad... ~-01rrJ~,~prio. Jn ~ ~ ~,. 1:1';~;.;r.i4-.::i '; - to' J ) r. ... UJ" T"" J; t tl:.I!:i"1 1 U'a 1J j., r:" . .. ,- 1;- ~ ,' -J I~ rI:,. - I i. . :. j.' 1;- " me I!' : .~rTnl~l:J/i':I:L~''JTI~u:t, .... lIr.r " I"I'iSVP1~/",";!iC~.r. CD' . \ ;.. '. . .-...-... ......... .. - -. i. oz C . " - .. - . - .-.,- - - ; L ,_-_" e. I' 4 r;= ...." . -: .-.. .' -. PLAINTIFF'S - . .. . --- ... -.,. . , ". , !.:: -J" .,.. - .-. } EXHIBIT Lfl&>2- '0 ---.,.~----.....~... ----.-..-.... ---- ...-.-_... _..- ....... -- - EXHIBIT ML-4'1b'2.. STO:) ___. - _0 _____ 438 A. J. LANZA AND R. J. VANE (28) Iron foundry workers show highest percentage of deaths from pneumonia, Statistical Bulletin, MetropoUtan Life Insur&nce Co., March, 1928, 9, 3. (29) BLOOmrIELD, J. J.: Engineering aspects 'of industrial epidemiology, Indust. Med., 1938,7,7. ' (30). KmBEY, C. H.:.. Pneumonia and tuberculosis among indUstrial workers, Am. J. Pub. Health, 1937, 27, 6. (31) HAYTHORN, S. R., AND MELLER, H. B.: Pneumonia, Ibid., 1938, 28, 483. (32) THOMPSON, L. R., BllI1NDAGE, D: K., RUSSELL, A. E., AND BLOOMl'IELD, J. J.: The . health of workers in dusty trades. I. Health of workers in a Portland Cement . Plant, Pub. Health Bull. 176, U. S. Pub. Health Service, April, 1928. (33) RUSSELL, A. E., BIUTrEN, R. H., THOMPSON, L. R., AND BLOOmrIELD, J. J.: The health of workers in dusty trades. II. Exposure to siliceous dust (granite industry), Pub. Health Bull. 187, U. S. Pub. Health Service, July, 1929. I I\ L1.: . 1 \ I ! i , ;t ,t. I: ,to , ~(1 1..~.'.._~ .,.. ~ \ .. .'-.' '".... -"-,. , " ;. 'Ie room ,ing free' 'ely low' '\1 insur:on ,carBritish ~is mor(ter age' 'm silica . to the' whether stantial ,t c1ear-~ ,; dusts. In avercertain n no inin mag;ome of he light, ')rtality disease n to our I 5t.ates ,kers in 1(1 more f) guide, 79, U.S. Bull. 231, lity from pt. Lab., in Dusty INDUSTRIAL DUSTS 437 (4) WHtTNEY, JESSAMINE S.: Death rates by occupation, Nat!. Tuberc. Assn., June, 1934. (5) Registrar.General's Decennial Supplement: England and Wales 1921, Part II.Occupa- . tional mortality, H. M. Stat. Off., London, 1927. ' . (6) Joint, Occupation Study, Actuarial Society of America and The Association of Life Insurance Medical Directors, 1929. (7) Occupation Study, Actuarial Society of America and The Association of Life Insurance Medical Directors, 1938. ' - . (8) SAYERS, R; ,R.,' Chairman: Report of the Committee on the Prevention of" Silicosis" through Medical Control, U. S. Dept. Lab., November, 1936. (9) SAYERS, R. R~, BLOOMFIELD, J. J., DALLAVALLE, J. M;, JONES, R. R., DREESSEN, W. C., ' BlltTNDAGE, D. K., AND BRIrrEN, R. H.: Anthraco-silicosis among hard. coal, (10) Na~ionmalinTerusb, ePrucubl.oHsiseaAlthssoBcuialtlio2n2:1,FUra.mSi.nPguhba.mHceoamlthmSuenrivtyiceh,e1a9l3th6,apn.d85t.uberculosis,' demonstration, Framingham Monograph No. 10, July, 1924, p. 69 (11). SY. DENASTmlU. CJK. HERy,gE.,.1, 9A3N0),)11B,I8U9T,T1E0N0,. R. H.: The physical impairments of adult life, (12) BIUTTEN, R. H., AND ThOMPSON, L. R.: A health study of ten thousand male industrial workers, Pub. Health Bull. 162, 1926, p. 161. (13) GAllD.NER, L. U.: Reaction of the living body to different tYPes of mineral dusts with and without complicating infection, Tech. Pub. No. 929, Am. Inst. Min. & Met. Eng., May, 1938. (14) PEDLEY, F. G.: Asbestosis, Canad. J. Pub. Health, November, 1930. (15) .MILLER, J. W., AND SAYERS, R. R.: The physiological responses of the peritoneal tissue to dusts introduced as foreign bodies, Pub. Health Repts. 49, January 19, 1934. .(16) COLLIS, E. L., AN)) YULE, G. U.: The mortality experience of an occupational group exposed to silica dust, compared with that of the general population nnd an.""'-'::i*iiWiii occupational group exposed to dust not containing silica, J. Indilst. Hyg., 1933, 15,395. ' (17) . (18) (19) (20) (21) . MACKLIN, E. L., AND MIDDLETON, E. L.: Report on the grinding of metals and cleaning ofcastings with special reference to the effects of dust Inhalation upon the wo:rke:rs....";"::l;:;~~.l U. K. Home Off., H. M. Stat. Off., 1923. COLLIS; E.L.: Industrial pneumoconiosis with special reference to dust phthisis, Milroy Lectures, 1915; reprinted by H. M. Stat; Off., 1919. DRINKER, P.: Causation of pneumoconiosis, Harvard School of Public Health, 1937. CARLETON, H. M.: The effects produced by the inhalation of hematite and iron dusts in guinea pigs,. J. Hyg., 1927, Z6, 227. Hcnlth protection in welding, C~M5UL~ Industrial . Health Section, Metropolitan Life Insurance (22) DOIG, A. T., AN)) McLAUGHLIN',A. I. G.:.Xray appearances of the lungs of electric arc welders, Lancet, London, 1936, ZJO, 771. . (23) ENZER, N., AN)) SAN))ER, O. A.: Chronic lung changes in electric arc welders, J. Indust. Hyg. & Tomeo!., 1938, ZO, 337. (24) LAN))IS, H. R. M.: The relation of organic dust to pneumokoniosis, J. Indust. Hyg., 1925,7, 1. (25) SAYERS, R. R., AN)) MF.RIWETHER, F. V.: Miliary calcifications of the lungs due to unknown cause, Reprint 1431 from Pub. Health Repts. 45, December, 1930. (26) FAwclrr, R.: Fungoid conditions of the lung, Part I, Brit. J. Radio!., New Series No. 99, March, 1936; Part II, Brit. J. Radio!., New Series No. 102, June, 1936. (27) DICKSON, E. C.: Coccidioides infection, Arch. Int. Med., 1937,50, 1029. A. J. LANZA AND R. J. VANE' ' far exceed those found for men in other pursuits, as to leave little room for doubt that silica is implicated. ' With'regard to ,silicate and other inorganic dusts not containing free ' silica, American mortality data are very meagre. The relatively low death rate from tuberculosis among grinders in the small American insur- , ance experience suggests that the effect~ of aluminum oxide, silicon car- bide and. other substances used in manufactured wheels are slight. Bl;itish data, much more complete, show lower than average tuberculosis mortality up to age thi:rty~five, but substantially higher mortality after age' forty-five for a group of men exposed to inorganic dusts other than silica' 'dust. Whether'this unfavorable situation later in life is due to the cummulative effect of such dusts with duration' of exposure or whether it is due to the inclusion in these occupational groups of a. substantial number of men who had been exposed also to silica dust, is not clear. There are no mortality data for men exposed solely to metallic dusts. Recent statistical studies, like the earlier ones, show higher than aver- , age death rates from tuberculosis among men employed in certain occupations or industries in which organic dust is generated.' In no in- stance, however, does the rate for a group of this kind approach in mag- , nitude the extremely high rates found among men employed in some of the occupation's in which there is exposure to silica diE'~Ri of clinical knowedge~ is, it possible to account for the on the score of damage to the lung tissue caused by The relationship between dust inhalation,and' remains a field for further 'investigation. ' A splendid contribution to our knowledge of this subject has already been made by the United States Public Health Service in the~r bulletins on The Health of Workers in Dusty Trades (32,,33). A greater volume of data. of this kind and more detailed studies of occupational. mortality are vitally needed to guide the work,of industrial physicians and hygienists in this field. REFERENCES (1) HOl'llUN, F. L.: The mortality from consumption in the dusty trades, Bull. 79, U. S. " Bur. Lab., November, 1908. (2) HOFl'lIAN, F. L.: The mortality from respiratory diseases in the dusty trades, Bull. 231, U. S. Bur. Lab. Stat., 1918. (3) 'HOl':r14A~, F. L., Chairman: Preliminary report of Committee on Mortality from Tuberculosis in' Dusty Trades, Working Conditions Service, U. S. Dept. Lab., 1919. Second preliminary report of Committee on Mortality from Tuberculosis in Dusty Trades, NaU. Tuberc. Assn., 1919. 915- ~rage os of )tton cent; ~ives, .,ified [sion The !:d to ere is C ocre to these 1,lberhem. that "is in .qngi. : are The utine "ases 'osed plete ional 'ally. (26) 'icate from r-cut. : has " INDUStRIAL ,DUSTS 435 an unusually high mortality from pneumonia (28) and the same is true of certain occUpations in the steel industry (29, 30). Exposure to dust is.associated with. some of .these occupations and usually extremes of temperature are also. encountered with such other conditions as would tend to cause dampness and chilling. So far as silica is concerned, a :i . .high mortality from pneumonia is associated with the silica trades, both in this country and abroad. Whether silica acts as a predisposing cause of pneumonia or due to the accompanying lung damage the prognosis is more unfavorable, cannot be shown from the figures available. For some years, a series of interesting studies has been carried on in Pittsburgh by Haythorn and Meller and their associates in an endeavor to establish any possible connection between the prevailing high mor- tality rate from pneumonia in that. city' and atmospheric pollution. These reports are interesting and' suggestive but not entirely' conclusive. The following quotation is from a recently published report of these authors (31). It is further seen ... that during .the years from 1932 to 1935 when the de- pression was at its height, when air pollution from industrial flues was greatly decreased and when economic and living conditions were at their worst, there was a great decrease in the number of deaths from pneumonia. However, the decrease occurred in females as well as males so that the change cannot be . attributed to conditions within the plants, such as overheating and rapid chilling of the employees. . _~...,,,,......~,...;i!,!!!",,!""",,:>: . SUMMARY Early occupational mortality studies focussed attention on the. importance of dust as a causeof.respiratory diseases. Virtually all kinds of dusts were implicated. Present day clinical and laboratory studies point to the seri<?us damage. to the lung tissue caused by a few dusts, notably silica and asbestos, and to. the. relatively little damage to the lung tissue caused by many other dusts. The most complete recent . mortality studies have been examined in the light of this clinical and laboratory knowledge. These mortality data, while yielding highly suggestive information, are very incomplete and permit only qualified general conclusions regarding the effects of dust exposure. on the incidence. of respiratory diseases for even the broad classes of dust with one exception-silica dust. The death rates from tuberculosis among men in occupatiomnn which there is' exPQsure to free silica so. .. .~ I ,,' f:. I i l\ ,Ii \ "' 434 . A. J. LANZA AND R. J. VANE In the American insux:anceexperience, .covering the years 19151926(6), also, the ratio of actual to expected deaths was above average for several occupational groups exposed to organic' dust. The ratios ofactual to expected deaths for the more important of these were: cotton mill operatives,176 per cent; woolen mill operatives, 134 per cent; upholsterers, 225 per cent; cigar makers and tobacco factory operatives, 174 per cent. The occupations discussed here have been traditionally classified among the dusty trades. One may well question, however, the inclusion in such a list of boot and shoe and of tobacco factory workers. The. great bulk of workers in these industries cannot be said to be exposed to appreciable quantities of dust. But taking the list as it stands, there is obviously no resemblance between the tuberculosis ratios .for these occupations and the very high ratios for occupations with exposure to silica dust. Some condition connected with the work of persons in these trades obviously is associated with the above-average incidence of tuberculosis. It may be that the less robust workers are attracted to Whatever may be the explanation, clinical findings would r7ri.';~_1i dust is' not an important factor in the high incidence of tuberculosis in. these trades. FUNGUS DISEASES OF TIlE LUNGS Dust may convey to the respiratory tract various types of fungi. Some of t~ese apparently have no clinical significance. Others are pathogenic and may produce either acute or chronic disease. The constantly increasing use of the roentgen-ray in diagnosis and in. routine physical examinations has served to awaken interest in fungoid diseases about which too little is known and which are not uncommonly diagnosed . as tuberculosis (25). Our knowledge of the subject is very incomplete but it is recognized that these fungus diseases are frequently occupational in origin and associated with dust inhalation and may result fatally. ;Mortality statistics are entirely la.cking, but the reports of Fawcitt (26) . and the recent studi"es of coccidioidal infection in California (27) indicate that such pulmonary diseases may be quite important. PNEUMONIA The effect of dust inhalation upon the incidence of and morta.lity from pneumonia has been the subject of much study without any clear-cut picture of the role of dust resulting (32, 33). The foundry industry has. .r ~ l: f. 'ion was .1atilized rts have Ilination ing fine is might c symp_ Ning an !ed that ron and nen exof this !nments 'I given ;d other ('d mor,~ where ,ade the ,Iustrial :)wledge 'Iinimize average "ith the lustries. 'Ised by ~trated ..,'ith inpicture f physi'rculosis number INDUSTRIAL DUSTS 433 of textile plants and he stated that there was no evidence of organic dust causing pulmonary diseases (24)- The mortality picture as regards organic dust and tuberculosis is confused. In the Registrar-General's Report (~), out of thirteen classes of textile workers, six had above average death rates from .tuberculosis .but.in only one class-wool, worsted, card, comb or frame (not spinning frame) .tenters-was the rate as much as 59 per cent above average. No .... TABLE 4 Standardized mortality (compareJIiH tnortalily figures) from respireJIory tuberculosis of males ages 20 tq 65 year, in occuPeJIions exPOled 10 organic dust compared with theJI of all occupied and. retired civilitilJ males taken 41 1,000. Englalul and. Wales, 1921-1923 OCCUPATION KOIITALIT'lIlATlO All occupied and retired civilian males:, ............ , .. , . ~ . : .. ,:: : Wool sorters............ , .. , .... , ......... , , , ... , , , ..'..... Cotton blow room operatives-skilled , ........ , .. . Rag grinders, wool willowelS, etc. ...... , .................... , ....... . Cotton card and frame (!tot spinning frame) tenters.... '. , , .. , ........ Wool, ,worsted .card, comb, or frame (nGt spinning frame) tenters ....... Cotton strippers and grinders and card room jobbers............... , Cotton spinners and piecers . ; ...... , ..................... ,.~.. , .... . Wool and worsted spinners and piecers......... , . , . , ... , , ..... , ...... . Cotton-doublers, winders, warpers, beamers, etc......... , ......... , , .. Wool and worsted-doublers, winders. warpers, beamers, etc... ,. , ... , . , Cotton weavers .. , ...... , .. , .... , ....... , . , . , .. , . , .... . Woolen and worsted weavers ......... , .......... ::........... Weavers of other textiles .......... , ..... '...... , , . , ....... '.. , . , ... . Boot and shoe clickers and cutters................ , .. , .............. . Skilled boot and shoe operatives, not clickers or cutters, ..... , ....... Bakers and pastry cooks............... , ...... "., . " .. ,",.,"',.," Tobacco factory operatives....... ". , ... ,., "., .. , .. , ......, .. , ,. , .. Upholsterers, coach trimmers, and bedding makers......... " ... , ...... . Drafters and brush makers .. , , .. , , , , , , , , . , , . , , ..... , ......... , .... . '1,000 1,065 750 1,093 1,057 1,591 796 1,072 898 869 510 '.~1 i',162 904 1,820 1,821 1,016 2,002 1,262 2,376 Compiled from Registrar-General'. Decennial Supplement, .England and Wales, 1921, Part II. Occupational Mortality. .other claSs showed more than 16 per cent excess, while in several classes the rate was quite low, On the other hand, boot and shoe factory workers showed an 82 per cent excess; tobacco factory operatives had 100 per cent excess mortality, and brush makers and drafters, 138 per cent excess. The rate for upholsterers, coach trimmers, bedding makers was 26 per cent above the avera~e, Table 4 gives the Standardized Mortality for the principal occupations exposed to organic dust, ,' ,<' ; ~': ~":( ~ :~~.. .::~::..: I .'1R: I I, ',f I I ". I .~ I " I I I , ; i,. I, :;;. I ! , ? , ~ " 432 A. J. LANZA ANDR. J. VANE dust was injected into the peritoneal cavity of animals, the reaction was inert. In the process of welding; metals ana metallic oxides are volatilized ' and inhaled into the lungs in a very finely divided films, taken during the state. ' Reports have physical examination been made of roentgen-ray wed an appeara.nce of nodulation resembling fine of welders, which sho silicosis. This has given rise to the question as to whether silicosis might be contracted from, welding (21, 22), a~though all these cases were symp- tom free. One of the cases reported by Sander came, to autopsy following an accidental death. No fibrous' tissue was found and it was concluded that were caused..by., collections of iron and the nodular shadows on the film carbon pigment in the lymph channels of the lung (21,23). No satisfactory statistics are available on the Perhaps there is mortality of men ex- as much. dust of this posed solely to metallic dust.. character thrown off in grinding as in any other process and the comments regarding the. mortality of grinders and nt here. of buffers and These mixed polishers, given metal a~l~~i! " under inorganic dust, are pertine dusts from the composition wheels do not seem to have produced tality rates from tuberculosis comparable in any way with those the silica hazard is severe. ' ORGANIC DUSTS Until the action of various kinds of dusts upon the lungs was s, the organic dusts, rising from made the industrial subject of processes, experimental studie were considered to be responsible for tuberculosis. Knowledge resulting from the extensive studies of silicosis has tended to minimize' the possible action of organic dust, both on account of the large average numbers when compared with the size of the particles and their small oncentration of inorganic dust particles found in various industries. c The presence of pulmonary fibrosis or other structural change caused by organic dust and associated with infection has not r is there evident, in been demonstrated connection with iIi- among industrial workers.' No dustrial processes involving exposure to organic dust, a clinical picture which could be compared with that associated with silica. . dis of. Philadelphia was one of a group of physi- The late Doctor Lan the first in this country to study tuberculosis cians who were among among industrial workers. His studies included employees ofa number " INDUSnuAL DUSTS 431 might have been expected and 18 deaths from influenza and pneumonia where 11 were expected. In the 1925-1936 study (7) there were 10 deaths from tuberculosis among limestone and. marble cutters where one was expected. Here agam, as in the case of the British limestone masons, cutter.s and dressers, the question is raised as to whether some of these men had not worked on, granite and other stones as well. Granite and sandstone cutters in the American insurance experience, as we hayeshown, had more th~ twenty-six times as many deaths from tuberculosis as expected. American iron miners apparently have a different type of exposure from the British. We have included them in table ~; somewhat arbitrarily, with the occupations' exposed to silica dust. There were 12 deaths from tuberculosis among them where only 1.4 were expected, or a ratio of 857 per cent. This very high ratio suggests that, in som~Amer;._ . ican mines, there may be a greater silica hazard than had been thought. The number of deaths was small, however, and ,the result cannot be considered conclusive. METALLIC DUSTS Hoffman {2), in Bulletin 231, emphasized the' da.nger of exposure to metallic dusts (pages 51-161), but the experience of recent years has not borne out his conclusions. There has not. been defined in the various industries. in which exposure to metallic dust occurs any definite or specific- pulmonary disease resulting therefrom~ All the .indications are' that, where pulmonary disease has been described in conjunction with metallic dust, the blame must be placed. on coincidental exposure to silica dust. Macklin and Middleton (17), reporting in 1923, point out that silicosis is associated with the use of natural grindstones and not artificial grindstones and make no mention of ill effects from metal dust. Collis (18) had stated the same general conclusion in his well known Milroy Lecture in 1915 and stated further that the percentage of free slllca is the index of harmfulness. . . Drinker (19) states that there are no <lata to indicate tha.t iron in the absence of silica caused pathology in any way comparable to silicosis. Carleton (20) states that hematite is r<;latively harmless compared with flint and other silica dusts; if inhaled over long. periods of time, it might cause fibrosis and tuberculosis but further evidence is needed. Under experimental conditions, it is a, relatively harmless dust. In a series of experiments b'y Miller and Sayers (15), when iron oxide i j ..\ . II .. i ; i \ ... 1 .l .~ I I 430 A. J. LANZA AND R. J. VANE t deaths. The extraordinarily high ratio of hile sandstone 1,150 per cent was recorded masons, cutters and dressers for tin and copper miners, w per cent. On the other hand, only the limestone .had a ratio of 441 masons, cutters, and dre.ssers in the nOnsilica group exhibited a high ratio, 191 per cent. aWt mhyanthyeosfe tmheemn shhaodu.lcdarhraievde osno thhigehir atraradteio; aist onnoet clear; It may be th time or another, in districts where granite or sandstone were cut and, consequently, had been exposed to silica dust. far as the occupations exposed to silica dust are concerned, as we So dings are in agreement with American insurance occupations exposed have mentioned, these fin experience. rganic Unfortunately, there are only a few dust, other than those discussed under silica and coal dust, to ino ican insurance experience and. none of these is iennctliuredleyd firnee thfreomAmcoemr plicating semxaplolsugrreoutpo osfiligcrai.ndeIrns tohfe m1e9t1a5l-s:1h9a2d6 Medico:.Actuarial Study (6), twice the expected number of a deaths from tuberculosis, while in a some- what larger exposure in the period 1925-1936 (7), ne and a half times the the number number of deaths expected. from tuberculosis was about o dstone grinding wheels have largely oeE~n:::~~~ . .Ibny rceocmenptosyietiaorns; wsahneels throughdoeurst winedreusetxryp.oseIdt tios dausfat ifrro..m..,"'.C..O...I..l.i!lIP~C.IvSul-:;~ tthioenrewfohreee,lst,hsaitlimcoonstcaorfbtihdee,garliunminum oxide; etc., . . some grinders were employed where lt sandstone wheels are stili in "use. is at variance with the. result for This comparatively grinders in'England favorable and Waies resu (5) who had a ratio of actual to expected deaths of 368 per cent.. That study covered the years 1921 to 1923, sandstone wheels may h~ve been and the proportion of workers using .greater than in the later American insurance experience. The report .of the Registrar-General brings out the important fact that grinders sandstone wheel is much in use, have in the cutlery industry, where the a much higher morta~ity than do other grinders. We have determined from the facts pr.esenteddin thhaislfrteimpoerst atshamtaanmyodnegatthhse fcroumtlerryesgpriirnadtoerrys t there were over seven an tuberculosis as expected, a; whereas among other grinders actual deaths were somewhat fewer than three and polishers of metal, times the expected. a somewhat similar group, were repre- t BufIer!f 26 American insurance study (6) by 17,000 life sented in the 1915-19 years of exposure. There were 10 deaths from tuberculosis where 7 INDUSTRIAL DUSTS 429 rapidly increases as age advances. In the Non-silica Group, the comparative d mortality is actually below normal up to age 35; it rises just above normal in the following age-grouPi but at ages over 45, it is conspicuously above normal. The report does not give the facts regarding the mortality from re- spiratory tuberculosisseparately for each of the eleven occupations'in- cluded in either the silica or the nonsilica group. Because of our special' re 10 TABLE 3 . I I I 'y Ratio of tictualto expected deaths from respiralory tubert:ulosls among males ag~ 2010 65 years, ;c "posed to spuified kinds of dusls, England and Wales, 1921-192J- ,11 OCCUPATION AcrUAL EXPECTED llAno , DEATHS DRATlIS PEII CBHT Silica Dust All selected occupations ................................ . 654 179 365 . Tin and copper mine-underground worken, not super- t- intending staff...................................... . 92 S 1,150 Potters' mill workers; slip makers; potters............... . 105 37 284 '0 'Eartlien"'are, 'china. etc., kiln and oven men, and kiln set- ters and placers........... ; ........................ SO 23 217 Metal grinders ...................................... 221 60 368 Sandstone miners and quarriers........................ . 36 17 212 Sandstone masons, cutters, and dressers................. . 150 34 441 '5 Nonsillca Dust c ABlrlicskeleacnteddpolacicnu.ptailteionmsa.k.e.r.s.,..m..ou_l.d.e.r.s., .e.t.c..,..fu..rn.a.c.e..a.n..d . 162 .......150.3, lOS " o crucible pot makers................................. . 34 33.7 101 .\- Brick, tile, etc., kiln and oven men ..................... . 15 22 68 Iron ore mine-underground workers, not superintending staff (Staffordshire and North Riding of yorkshire)..... . 13 24 54 . limestone miners and quarriers........................ . 39 . 3S.6 101 . 2 Limestone masons, cutters; and dressers ............... . 61 32 191 ., 'Compiled from: Registrar-General's Decennial Supplement, England and Wales. 1921, Part II. Occupational Mortality ,'0 interest in the facts for this particular disease, we have calculated, from the original report of the Regist'rar-General (5), for each of the selected I'e occupations, the number of deaths froni respiratory tuberculosis which h might have been expected on the basis of death rates prevailing among 'r- all occupied and retired civilian males between the ages of twenty and p, sixty-five. These results, together with the numbers of deaths which actually occurred, are presented in table 3. Each of the silica ~ccupations had over twice the average number of ~I~---------- .--.---.-~.--' .._--- ------ ' , ' ,., I . ll:::- 428 A. ]. LANZA AND R. J. VANE INORGANIC DUSIS OtHER mAN SILICA, ASBESIOS AND COAL DUST Many industrial dusts contain silicain combined form, as distinguished from free silica, such as combinations with magnesium, iron and alum- inum. The effect of silicate dusts upon the lungs, with one exception (asbestos), is problematical. Where exposure to silicate dusts occurs in industrial establishments, under circumstances which might be thought hazardous, one does not see the clinical picture which is presented where free silica is involved nor is there evidence of disability and tendency to infection. Extensive animal experimentation with' silicates, both by' . ~r inhalation and intraperitoneal injection (15), fails to produce any disease akin to silicosis or other evidence of definite. disease. It is doubtful whether there is a definite disease to which the' term silicatosis can be applied, although such a term has been devised. Certainly, the last word has not been said with respect to silicate dusts. Similarly the dusts of a.luminum oxide .and some other a.rtificial abra- sives, of. hematite, and of other inorganic dusts have not been shown to be the cause of marked pulmonary damage. Mortality ".~~:~'~.~~~~ .ri" emphasize the distinction between the effects of dusts containiiig <,IIi and other inorganic dusts. This is very strikingly brought out .r~',:i'_ sotfudEyn,gblaansedd aonndthWe aolcecsup(a5t)i,o' nbayl mCoourftsal-iatynddaYtauQlef (16).. These .........,.v~" ..,', selected ~or study two groups of occupations-one exposed to silica dust and the other to nonsilica-so chosen that ea~h had as far. as possible the !~ .:; .. . same amount of dust exposure, physical effort, exposure to heat or to weather, ot any underground environment. Part of the authors' com- ment on the results as regards respiratory tuber<;:ulosis is quoted: , . For all ages (20 to 65) the C.M.F.' of the Silica Group is no less than 592:2 against 163.5 for the Standard Population, i.e., the mortality is more than three and a half times the normal. For the Non-silica Group, the C.M.F., although actually slightly higher than normal, at first sight hardly seems to differ significantly from the normal; nor would one's judgment be much af- fected, if instead ot making comparison with the Standard Population, one had used the Social Groups III and IV, for which the respective C.M.F.'s are 159.8 and 164.2. But the summary figures conceal interesting' changes with age. A glance at the figures shows that in the Silica Group, the ratio of mor- tality to the normal, though greater than unity even in the lowest age-group, Comparative Mortality Figure: This figure is defined as the number of deaths that would have occurred in the Standard Population at the rates ruling in the occupation t ; ;1l1y, low, ~her, a.nd lIe 2. (9), 11ical , 1 to In a. ',tio cent lIai to 'ccted :!l8 ~34 161 Asso- ~ociety ,I that 'Iother 'l11inac (11) were 'nd by IIstrial !cwas II pul'nining " INDUSTRIAL DUSTS '421 employees; at ages 45 to 54, in 10 per cent;.a.nd at ages 55 to 64, in 20 per cent. No such rise with age occurred in any general population group for which comparable data are available. The prevalence of tuberculosis was greatest among the rock workers. The. . , next to the highest rate occurred among. anthracite workers' who had changed more than five years previously from very dusty to relatively non~dusty occupations in the industry. .The third highest rate was exhibited among persons who had had appreciable exposure to harmful dusts in other industries. Among the regular miners working at the face, the rate was definitely higher than in the control group (men whose dust exposure averaged less than 5 million particles per cubic foot) which showed a prevalence rate of less than 1 percent. When the termor service exceeded 20 years, more than 2 or 3 of which involved exposure to heavy concentrations of rock dust, about 37 per cent of such employees [classified as rock workers] showed evidence of pulmonary' tuberculosis. .Service of' 25 to 34 years was associated with a. tuberculosis rate of 8 per centamong non-rock workers employed in the haulageways, of 14 per cent among the regular miners, but with a rate 'under 2 per cent among men exposed to less than 5 million dust particles per ~ubic foot of air. Asbestos: Exposure to asbestos dust may produce a pulmonary fibrosis which; like silicosis, may cause disability and death but which does not appear to carry with it a. predisposition to tubercle. infection and which has a pathology quite distinct from silicosis. The circumstances under .. which asbestosis will occur are not too clearly defined and un(iouLbt'edt9'9#;i~r'!~i there has been a tendency to classify as asbestosis cases in which the causal relationship of asbestos to the condition present has been assumed . rather than proved. . Our knowledge of .asbestosis is based on individual reported cases. I .The actual number of fatal cases of asbestosis, supported by postmortem examination, is too few to have any statistical weight but the disease itself and its pathology have been clearly demonstrated. Gardner (13) believes. that the action of asbestos dust, unlike silica, may be mechanical and not chemical. If this is so, it would well explain some of the con- \ fusing aspects of this disease.. The cases described have originated in I textile and other asbestos fabricating plants and not in connection with the mining of asbestos. Pedley (14) found that the tuberculosis mor- tality rate in Thetford Mines (whence 80 per cent of the asbestos used in the United States is derived) did not differ materially (rom the rate of the Province of Quebec as a whole. 426 A. J. LANZA AND R. J. VANE ard lives. Compared with the death raitteumfoirnloaubsorminignegrrsouispsqgueinteeralollwy,, therefore, the tuberculosis rate for b acite minerS-is as high, if not actually higher, wthhaenretahsethoavfeearrcaattgueeaflfootroratenhxtiphserccltaesds doefawthosrkfoerrsc.oaTl mheinne:rusmisbegrivoefndienatthabs laen2d~ . Public Health Service report (9), the ratio n :from the The following quotatio previously referred to, is of interest in showing the incidence of clinical tuberculosis among anthracite miners: 2;Sevpeerarlcseunrtvoefysthheavgeensehroawl andtuhlat twthuibteercmualolesipsoopfutlhaetiolunnogfs tohcecucrosunatmryo;ng I1ntao TABLE 2 .. ' NumbOerrdoinfadreyatDhsepOaMr.trmateiontoMf (oJ(rJtUaIlJiltyto' E"px,peelreiedndc,ea.ot/fuAfrmomerictuabneLrciufeloIsnissuorfa1nMcereCsopmiraptaonri,essystem Coal Miners ~91S-1926 1925-1936 OCCVPATI0M Actual deatlll' R.atio . per cent actual to expected Ratio t Operatives not underground. , .,. , ..... , . . . . ... """'.'.14. 159 __.I::Ii'#~~~~~ :;. Operatives . Total... underground ............. . . . ,... .. .. . .. .. .. .. .. 125 157 115 334 POetnhnersylolvcaanliitaie{sm,(boisttulymainnothursa)c..it,e.)..........,.. ',".. tt 20 161 Complied from: Joint Occupation Study, Actuarial Society of America and The Assc-29; and Occupation Study, Actuarial Society ciation of Life Insurance Medical Directors, 19 of America and The Association of Life Insurance Medical Directors, 1938. Data not available, ,1. study of tuberculosis in Framingham, Massachusetts (10), the disease in an active it was found that form, and another about 1 per cent were suffering from 1 per cent were classified as having arrested tuberculosis, Physical examina- tion of 100,924 adult white males made bout 1i by the Life Extension Institute (11) per cent when suspected cases were indicated a preva,lence rate of at higher a percentage, namely 2; per cent, was found by included, the Public A somewh Health Service (12) from the examination of 10,000 male industrial , workers. Amohg the anthracite workers examined, the clinical tuberculosis rate at ages 35 to 44 cliniCal was pul- bmeolonwarynoturmbearlcuinlosthisewyaosudnigagernoasdeudlitnaagbeso,utb5utper cent of the hard coal mining there many J.edly posed 'rwho r mor!.lmber )a.rent . from '.4 exlimber leaths : from period 'rently "se ocligures ltmen death crease -1926. is pre(! from 1(1.sons,. c; and Ratios : social ; ':pes of :; from United y parts n silica .ject to termed ,.'a.ses is INDUSTRIAL DUSTS 425 high among certain groups of miners while among others the death rate from tuberculosis has been consistently low. Recent investigations have cleared up many points about the hazard of coal dust and have indicated certain differences between anthracite ccial and bituminous <;oal. It is I . desirable, therefore, in studying the effects of coal dust to consider these two types of exposure separately. In 1934, the Public Health Service (9) made a report on an investiga- tion' of pulmonary disease among anthracite miners. This report stated what had previously been suspected, namely, that anthracite mining had, under certain conditions, a silica hazard and many anthracite miners were exposed to the effects of coal and silica dust. The evidence tends to show that disabling miners' asthma is, in effect, silicosis, a silicosis modified by coal Q.ust but nevertheless a silicosis. -. -- "- - .. Turning to the mortality record of coal miners, we find that the Medico-Actuarial Occupation Study (7) shows for the Pennsylvania miners (nearly all anthracite) the following figures, based on 144,535 life years, for the twelve-year period 1925-1936: There were 1,699 actual deaths where 613 were expected, giving a ratio of actual to expected deaths 'of 277 per cent. Of this excess, 37 per cent was due to accidents ~'.~~!i! and 63 per cent to disease. The pneumonia and influenza death rate' was five times the normal; tuberculosis, over three times the normal; and' accidents, five times the normal. ._,c.'" .... :....".,.r.. ~~~~y Miners elsewhere (bituminous) presented the following figures: There - were 52,522 life years and 330 actual deaths against 187 expected, a mortality ratio of.176 per ~ent, but of this excess mortality, 84 per cent was due to accidents a.nd 16 per cent to disease. The death rate from accidents was five times the. normalj the pneumonia death rate was normal; and the tuberculosis death rate, 61 per cent in excess of normal.. In the insurance occupation study (6, 7), as we have pointed out, the death rates for each occupation are compared with the rate for standard ordinary policy' holders, a rigorous standard as compared with the rate for all occupied males. When cons~dering the mort~lity of men employed in mining operations many of which are carried on by unskilled workers, it is especially necessary to bear this fact in mind. Apart from any specific occupational influence conducive to a high incidence of tubercu- losis, we should expect a greater than average mortality from tuberc:. culosis among them b,ecause of their economic status. Insured common laborers outside of the mining industry, it should be mentioned, have a death rate from tuberculosis about three times as great as that of Stand- , I 424 A. J. LANZA AND It. J.VANE miners, but in the earlier study (6), covering the years 1915-1926, there were 11 deaths from tuberculosis in this group or eighteen times as many as expected. The ratio for iron miners, 857 per cent, is unexpectedly high inasmuch as it is thought tltat most of these workers are exposed to only moderate amounts of silica dust, except for Ii limited number who are working in hard rock. It might have been expected tha.t their mortalitywould more closely approximate that of coal miners. The number. of deaths is small,. however; and the difference may be more apparellt than real. . Among cutters of granite and sandstone, there were 38 deaths from tuberculosis in an exposure of 5,944 life years, compared .with 1.4 ex- pected, or more than twenty-six times as many as the expected number of deaths.. Chippers of. metal (exclusive of ship chippers) had 16 deaths from tuberculosis where only one was expected.. It will be observed that the ratio of actual to expected deaths from tuberculosis for each of the silica occupations is higher in the period . 1925-1936 than in the period 1915-1926. The reason for this apparently lies in the difference in the trend of the death rates for men in these oc- cupations and the rate for insured persons generally. While the figures a.re too small on which.to base broad conclusions, they sUQr2iiiliil in silica. occupations have not shared in the general decline in rate from tuberculosis.. It may be that there in the rates for the period 1925-1936 over that w~a,s~t'C'"I;.';-I:.iU:Q:!.lfl:Y:;~r'::'(~ Interesting. confirmation of these high ratios by English data is pre- :;: sented in. ta.ble 3. English tin and copper miners had a death rate from tuberculosis eleven and one-half times the average; sandstone masons, cutters and dressers, nearly four and one-half times the average; and metal grinders, about three and two-thirds times the average. Ratios such as these cannot be explained away on the ground of differing social .classes or the selection of the q,ccupation by physically weaker types of workers. This evidence is in agreement with reports of silicosis studies from South Africa, Australia, Canada, and Great Britain as well as the United States and is supported by clinical experience of physicians in many parts of the world whose practice has been among workers exposed to silica dust. . CO!1:Z dust: It has long been known that coal miners are subject to chro'nic pulmonary disease characterized by dyspnoea and usually termed "miners' asthma," also that the death rate from respiratory diseases is '1 y tic of rc- 'c)n en ry. 11gS '. to line lhe ;ons eak s is pro- lanThe has \ by INDUSTRIAL DUSTS . 423 No . useulpurpose would be served by quoting , extensively from the impressive volume of mortality data available to show the influence of silica dust on the incidence of tuberculosis. Virtually every one of the many studies is in agreement in showing extraordinarily high mortality' rates from tuberculosis for industries and occupations in which large numbers of men are known to be exposed to a real silica hazard. These rates are so high, in fact, as to leave no room for- doubt of the cause- and-effect relationship between the hazard .and the high mortality. A few figures from the insurance investigations (6, 7) may be quoted. Table 1shows the ratio of actual to expected deaths for the chief occupa- , tions exposed to silica dust. TABLEt Number of deal/IS and ratio ofactual to expecJetl deaths from tuberculosis of tM rupird.lory system Ordinary Department Mortality Experience of American Life Insurance CompaniesOccupations exposed 'to ailica dust 1915-1926 1925-1936 OCC1!1'AnON Actual deaths Ratio per c:ent actual to expected Actual deaths Ratio per cent actual to expected Stonecutters-granite and sandstone.......... 16 Chippers of metal-(not shipbuilding) ...'. ~ " ... 8 Mine operatives-underground Copper mine operatives..................... 24 Gold and silver mine operatives ............. 9 Iron mine operatives.. ; .................... 4 Lead and zinc mine operatives...... ; ........ 11 Other and not specified mine operatives ...... t 976 615 913 804260 1,833 - 38 2,639 16 1,667 ~<.>:29.,. , 11 12 3 10 >1,,38~. . 940 -857 1,020 - Compiled from: Joint Occupation Study, Actuarial Society of America and The Association of Life Insurance Medical Directors, 1929; and Occupation Study, Actuarial Society of America and The Association of Life 'Insurance Medical Directors, 1938. t Data not available. Among a group of underground miners employed in mines other than coal mines, nearly all of whom were employed in metal mines, there were 65 deaths from tuberculosis in the years 1925-1936 in an exposure of 25,000 life years where 6 were expected, or about eleven times as many deaths as the expected number. There w~re 13 deaths from pneumonia where 5 were e~pected. Tuberculosis deaths were fourteen times the expected among copper IJliners, nine times .the expected among gold and silver miners, and eight and a half times the expected among iron miners. In this experience, there was only a small representation of lead and' zinc .. ' ,j' ;1 'ii' 'I' .,'j:. . ':)j:: ,:: ; . 1 ------. .-*M.Mt~..... t~. . . . . . . . . . . . . . . . -!> . ~', .422 A. J.' LANZA AND R. J. VANE These are the Registrar-General's Decenniai Supplement for England and Wales (5) and two studies made jointly by the Actuarial Society of America ar.id the Association of Life I.nsurance Medical Directors (6, 7). In the English study, the tuberculosis death rate for men in a given occupation, ages 20 to 65 years, is compared with that for all occupied and retired civilian males of the same ages. , The. method of analysis' employed in the insurance studies was to compare the actual number of deaths which occurred among men engaged in a specific occupation with th~ expected Ilumber of deaths calculated on the basis of death rates by ages P!evailing among standard lives, that is, persons who buy insurance on an annual basis in amounts of $1000 or more and who are not employed in hazardous occupations. Thus the insurance standard is a more rigorous one than that of "occupied males in the general population" since those in the lowest social-economic class are excluded, as are men who are employed in occupations where there is a serious exposure to dust, accident or other hazards. This should be kept in mind' in interpreting the figures. presented for insured lives in the following discussions. INORGANIC DUSTS Silica: Silica in the form of dust' produces a . disease of the lungs, namely silicosis, a progressive fibrosis itself, may disposition tcoautusbeedrcisualboiulsitiynfaenctdiodn~e.a,t. hSialincodsiws hic~h,~:,:~~~ft~~~~ of dust containing free or uncombined silica. Its pathology has been extensively studied, both clinically'and in the experimental laboratory. It has been established that silica particles which penetrate the lungs are under ten micra in their largest diameter and are mostly froni one to three micra. Not only must the silica dust be in a state of such fine subdivision, but the particles must be present in large amounts and the exposure of the individual must be prolonged. When such conditions are fulfilled the natural defenses of the body against inhaled dust b,eak down and silicosis results. ,The precise nature of the action of silica dust upon body tissues is not definitely known but it appears to be a protoplasmic poison and produces its effect chemically and not mechanically. A given dust is dangerous in proportion to the amount of free silica which it contains. The nature of the relationship between silicosis and tubercle infection has not been determined, but the fact of such relationship is attested by overwhelming evidence both clinical and statistical (8). INbUS'IlUAL DUSTS 421 There are reasons, obvious to us to-day, why these mortality studies' have not been an entirely accurate guide. .For one thing, students of mortality did not have the benefit of the clinical and'laboratory knowl- edge regarding dusts now available and, consequently, had to make their own classifications of dusts on a somewhat arbitrary basis. They were handicapped, too, by' the fact that the existing occupational codes of~en brought together all the men in a whole industry. This did not permit of detailed studies of the mortality of men exposed to a single, type of dust. Occupational mortality 'sta~stics still lose. much. of their value , because of this same lack of refinement in methods of classifying occupa- tions. Then again, factors other than dust, which have a marked in- , fluence upon the incidence of tub~rculosis among men ,engaged in differ-' " ent occupations, were not as well' understood' and were not given due , consideration in interpreting the results of mortality studies. There are pitfalls in reasoning from cause to effect, espeCially' where j tuberculosis is concerned, and the error of post hoc ergo propter hoc is I particularly to be guarded against. A high incidence of tuberculosis or other respiratory disease among men in a given occupation does not I I necessarily indicate the existence in that occupation of a definite oc- I I cupational hazard. It is well established that people of the poorer economic classes, whether in industry or out of it, have a higher incidence' I of respiratory tuberculosis than do people better off financially. In ~~ Miss Whitney's (4) study of Death Rates by Occupation in, Ten States in 1930, the standardized death rate for tuberculosis was ~over"twice :a.s-:...:,;.:.:.~.:::#~~~ high among, unskilled workers as among all occupied males while in the .,. Registrar-General of England and Wales' study (5), 1921-1923, the rate for unskilled workers was about. two-fifths higher than the rate for all . occupied and retired civilian'males. Certajn occupations, too,are more suited to the physically weak and are selected by them as a means of earning a livelihood. When the followers of an occupation ar.e recruited '. from the ranks of either of these classes, it is to be expected that a high r '. incidence of tuberculosis mortality will be found among them. Failure '11 to take cognizance of these factors as possible explanations of a high tuberculosis incidence in certain callings has led to much misinterpreta- tion of the significance of mortality findings. . It is not our purpose to reassess the older statistical material to which ' reference has been made. We shall limit our discussion of statistics 'y mainly to the results of the three most recent investigations in which. tuberculosis dea.th rates are obtainable for a number of occupations. ",'il ;,, : "; ,. f :11: ~ " " '" "j; I I i i ,~ - ;- I 420 A. J. LANZA AND R. J. VANE In 1908, Dr. Frederick Hoffman (1) wrote an article on the mortality from consumption in the dusty trades. Ten years later, he produced the well known Bulletin 231, The Mortality from Respiratory Diseases in the Dusty Trades (2), an important milestone in the hygiene of industry. In 1919, appeared the first and second preliminary reports of the,Com- mittee on Mortality from Tuberculosis in the Dusty Trades (3), of which 'Committee, Doctor Hoffman was Chairman. An' indefatigable worker in many fields of public health, Doctor Hoffman's name is thus linked to the, early authoritative publications in this country dealing with dust and pulmonary disease. The various reports of Governmental Com- missions in South Africa, Australia, Great Britain and other countries have also stimulat~d industrial studies and laboratory research into the effects of many kinds of industrial dusts, especially those contai,ning ,silica. . ' __ - --' - . At the present time, while no one would state that we have adequate information abo\lt the effects of the inhalation of industrial dusts, we do know a great deal mor,e than we did twenty years ago. Both clinical and laboratory studies have given us some knowledge of what kinds of dusts are dangerous, the circumstances under which they are dangerous, and the nature of their action'upon,thepulrilonary tissue. We learned a great deal about the prevention and control of the dust by engineering methods. But when we seek evidence of the effects of dust inhalation in mor~ality and morbiditY.,Jecords"we :Wll..L,..,.Ii,.-Uilli~;;;'UJ,~ statistical demonstration of mortality and morbidity due to the inhala- tion of dusts is anything but satisfactory or complete. , This situatiop is the more regrettable because comprehensive mortality and morbidity statistics would, be of the greatest value in clearing up many doubtful points regarding the effects of specific dusts and would bring to light occupations in which there might be areal, but unsuspected, exposure to injurious dusts. Early occupational mortality studies, it ~ust be admitted, gave the first broad clues to the extent of the dust hazard in industry and to the kinds of dust which are ,most. injurious. These earlier mortality studies, valuable as they were, however, were in many instances misleading. Virtually all kinds of dusts were shown to be productive of tuberculosis rates higher than average, whereas recent clinical and laboratory experience points to the very considerable damage to the lung tissue produced by a few dusts, notably silica and asbestos, and to the relatively little evidence of harm done to the lung tissue by _ organic and many inorganic dusts~ '"am, men i in- lings luals f the ;;sed. .7.35, York ':mual 1938. :,Am. X-ray . 1937, \t. J" ~n, J. r1;\ ,; ~ .~ ., INDUSTRIAL DUSTS AND THE MORTALITY FROM PULMONARY DISEASEl I \' A. J. LANZA' AND R. J. VANE' 1 Air and water are the two immediate vital necessities of our lives. l We take extraordinary precautions to guarantee for ourselves not only i an ample supply of water but one of defined purity, and vast engineering water-supply projects, costing many millions of dollars, are an accepted. and commoriplace fact in our times. . With respect to the air we breathe, we are more complaisant. Dust arising from industrial processes pollutes the atmosphere of working places, in mine, factory and mill, and the products of combustion, both industrial and nonindustrial, are liberated into the' atmosphere of our I communities with little restraint. In recent years, particularly, in- dustrial dusts have received much attention and much effort has been ."put forth by industrial firms of all kinds to control dusty processes in tI their establishments. I ! Fortunately, nature has furnished us with a respiratory system which has not only a large margin of sa.fety, but a fairly efficient protectiy.~"~s",,~~~~~~ I mechanism. When that protective mechanism is subjected' to severe I I stress for a sufficiently long period of time, it may fail. The extent to I I which such failure may be reflected in mortality experience is, within certain limitations, the subject of this discussion. I I We are concerned here'with industrial dusts otherthan those commonly recognized as poisonous. Lead, mercury, arsenic, manganese and other I systemic poisons are excluded,. together with the chemical poisons. I Those dusts with which we are concerned are both organic and inorganic, and the latter, in turn, may be subdivided into metallic and nonmetallic. I There are many possible subdivisions of these three classifications but for our purpose extensive subdivision. is unnecessary. Indeed, it is difficult I to get sufficiently ample statistical material to give us definite information under the general headings. 1 Read as part of the Symposium on Tuberclilosis in Industry at the joint session of the Pathological. Clinical, Sodal Work and Administra~ive Sections at the 34th annual meeting of the National Tuberculosis Association, Los Angeles, California, June 23, 1938. 2 Me "ropolitan Life Insurance Company, New York City. ". 4i9 . I ~ I '--\ f, . Dr. JiOr=&:l hurnett.e 0" - 2- I o ..~ . J . j ...... t ~ 1~1: -prd'er t, lene! Or:1ee 80' t~~~sh the R~a~ hI:. J:&trrit.l in w~ 1eh 1C'U or .n~ld ,~U wtab ~ tl::ir,1f to do h~ w:>uld be I,Dternted -r. ",r. ~u~!eIabwU' .MT6dw1ca~ll1aDt ipr.ecJct1onr,CPare-ra!dOaDrneml ettlr!'J~oc.t~"aru.rmara..~o,SafetyMeDCifrtleluc::t.,~and "'}'ectbd~. 1.0 ,.r 1,00=>, tbdr clailt aeco:ot!4..ng W ratl, a, 1':)u )-.now, te rmminf da~ wUe!;) the7 hU'e -at band. Cl:rreDtl1 PfL\:. ..a!l arolnS reael,ec! . ..Jii. ( dur1nr A.u:;uet, which ft.!!; m~re t.haD dotG n,t b~ll.Te ~~.t t~e8e fJat.. talee th1" Z'at.e, I ~l1fTe are all tor l.r.itim~te 11.Df hu1'1P.an B~ 1. \ ~rtlcularly critical or the ~rt olayea by the C~E"ny ~~1c~ lza:loera tihn eeirld1'tollaodwm-u!J'n) h'rtir"aitt1!.!=d. ldi .n",t&1adidthint1th.eeree~n~torrcll3'ntfrau!.lAiendgetilr%l'ntrh. dBrewsotr&ktea.Ddd . t.h3.t th~ COII'O&D1 ah~Uli ell2,,107 lab?t.toT1 e7.U1Dlt!.!')n, z-raY8, etc., to chec'k un .,n dT&lar.ucen"C,!Ul"el;t!El.~~stel!8lUubc!th1tatl.ld}lbl7ood . '\ attendirlg Jt!:ys1eianl. the T'J"ed'~1n~t ~llL;.non. are neur&l!thenla ca1cnflS, tc,;., r.=ue t.::Itd.a. anc! oeeur &~"nr th asaeeblr depl;.rt!!ent, nlel~ ha! bbt1\.~ 9) UT'ln~eeF, Of.rt1c\!larl~.. 'Oerce."2t. te.mue!!. it: t",!' rae' ~ al,o Til AII1ut..,! D.r. ~teT~lo:'", w~., Wedleal kx.!lner f~r the C0Il2~n1. b He the Jehnl-I't.nTl11e tt.y!1c~en; :e~t1oDed that ec~l~,ee! .ere 11 I I at'\1!~ng 81cnln their A':H bp::.zr6nce. He hAt tt.lked ~~ cert!rlccte~ and their excuse is .. ith that lncal .-.brriciaD' aht they are aceomEodatlDt tl:.e1l" th., ptnatbioeln~tsl.ettOeDrIR~~~nthth~atrt~e~~~,1r..~~,~p~hy!11scRtIaTn~~~ stu~rgtchseteadttt.hnactintghe~hCy~p.mi~ely.n~rtolntrill \ out, t~at the inSUTbnCe 11 ~~t !DteDded ~ WOTer Tacatl~D', re!t ~er1ote. etc. ,I ,o.,ur that r 1 did !l~t kDoa w~ulc pa it ~D wht't~.r t!:h tn you t~ d~ c"'me! .1~!.D ~ateTfr 1~u lee 'DreTince, tit. but. I thouet;t Sincerel, y~~s, Ce~rCf f. Ihe~tley, ~.t. A~!!e~t Vedlc~l ~1rect~r 145 ........__ ._.._______ ~----...- - - - - - -..... ___ ..._ ....... ,,-.0 ".:. _ " .. -....., ... --- , -.....--.-.,....":7'.,...,..-. ,:"'!" :-;-:- -:-.~~-To_--,.-_~------.'---:--------~.r." ..-........-.--- . - . , . - , .. , .~ ' I .. .- ---.---:.-. Dr. No:"IU.:J 1.~ 'bU1"Dtt te "ehte.!'ll St-eret!.:.r1 Cana~l.~ ~r.d u~~~ee l.,..:r ~ue!t! "'r..nair J"f'~a~!r.g c.,~u.9)lt~ hf'lc.1tb aerTie and liT~nt c":le1t1.~:lt, wi-.ie!'! y,,:u Tll.nned t!') Bene t:- the' !~ur~e! hI e.,::o:u."llt1ep. 11) which we arf ~a~lnr the. tul:'.. rcw.nrh tl""%'ul1't.y !ltu~j. reached me t"c5ay. I think ~t cO'Ytr! en1'::t~inr we talked &b'\ut !atu1''''>, an~ ,!."'Olld gi'Ye Uf! the necenary int'"!r:altbn. .-.,1' Le ..,.,!!~ "le r'u l~tt~r t~ct in Jlb~.,w!'lcl. If it. leem. n.c~~!an- tJlC we arl'. ~n d'3Ul:t at,"ut ennciU-n, it may Itt t:" ~h an l.netleet! "'n 'Y'1!1t latu ~n. ! aPlume f'1'''''' your CaD .eeure t~t In~nr:ati~n fre:. tru~ted source known t'" 1~~ If y"m I.rr !n d~ubt 6~"ut a lIIource 1.:0 !8b(!!lter, I be~ ie'Ye T ~1U1 !IIf'e'.:r~ t~ '. s ~:~:%'It~t' '21 t.~r"'.Ur,h tr. !:! t:~, the .s~! tront tI.J Dr. st.e'Ye%lson &t C_nac!a" J"\hr.!~~'Ytlle in Alt.I~ I h~ve eE'YerLl ~U[;!tc'!n! w~,~ch I r!ld ft"'t talce 'up with y.,u "n Saturday whtch r.,ltt< t.'" ::.y Ttslt. (1) br. GrL~a:t R~!'ft Medical J,irecf,')r af ~ati"nal Dr. r-TE:1a:(riell!," ~.~~Iltru.l. WII~ 1nter(!tto~ 1r; -:ur indu~t.tt:al heuth mter1al. lie bal a~~wt 25 ~y!ici&ne in hie ~~re~F!~nal ~rL~isat!~n w~1ch he anr Pilc!ell, kectcol ~irect~r ~! Il~inum C~m~~y ~r Ca~kd~t ~re o1'eani&tng. He e~uld u~e :5 c~~ie! ~r *~~ropr1ate literAture rar the" .L~. ~ y~u ha'YI 1~~11el ar ~ur Tndu"trh.l !!et.lt~!i!.rtu a:lC! d"\ '''U t\1h to I~"lr Dr. hou'w1t" them' (2) tr. Ci. IC. McGaw, 'n char,e '!!f tncust:'le.l Pelat! .,DI ~t Ce.nac!1an J"\hn!l-~v111e, A~~!t~8t CU~.t 1! tateresteC in havlr.~ h~.lth edue!ti~n .at.rial for educat1~~ work .Ith thE1r~m~1~ye[! in A!btp.tos. they h*v~ ~eome quit. aeti'Y~ in a.rety educ~tt~n L~C n~~ went t., turn ~ hpnlth edue~tI"n . St .ant~d t~ ~ sur~11ed ..it', t~e hc.uth eCi:cat!"'n Qlt.te.rttJ. ~1eh .f, have avaLaUe. J)f'I Y"'U hEV~ l1t.er- 6turt y~~ can tend hi.' It n~t, .hat de y~u .1!~ don&' I r.ihht al~~ ~ent'nD t":4t 'r. VoeCn r::.hed tJle :::ulatc"n ab~ut 1)U%'!ir:& !lemee. He &e1C: that t.h~ h:nrt't!1 ~n h~d bu:, ,;'Yen t~e= t.~!. t ~b"r w~uld hut nnreing . ."ice w'le::. t..~e 1n~urbnce WwP ~urchosed. 1 expl&il)ec ~~ht .e UT~'Yldt nUTtiD e~rT1ce wher. it \en.,. h avd.~"Heanc t.~~.t w,uld the bacl:e=1'~und ar tl l.i n')t and necessui:y tollaw the e':'ntract. Y"'u may s1lh t,,, e&)' 1"\!l,thinG tf., lou hl ne1'ha?1 or t Tn c~Meet1"'n w1 th the nursine .eniee, I p'Ye l~i 18 (),'.n the I)ame! fL t.i. II&a;er, the t ., mines we in!ure 1n ThetforC, 1:-. 'l. C. ~1 th ~f th. kll IUnes, IJlC tr. !ndre s Jr:'Ihn!~n, cr J"bl)!~n'l' kine. ' She 18 "lanDing t" ca.ll on t~e%!' t~l! . week ' (,) Yr. Y'un ~ab:'lurln h also 1ntfre~ted in lIt"tro~olttan he!J.t~ l'teratur. T s~ll arrange t~ ~ut h1~ ~n the ~tot\~t\cal Sull.t.1D YA11i~t l!st, ~ut am In doubt a! to ahat y"u ~rert1' t"\ do ab.,~ at'ler heAlth lIterAture. 'n~d 144 a Dr. NO:"lU.:) 1.. U!"D[' t te A!e1~t&nt Secre~~r1 C&na~1a~ ~~a~ v~~~ce "'11. 1-:.;:- ~unt! "'r.aairs "E',:;a~!ng e":le~:t"\~:lt, wM.c!'! ,-":", 'r'lr.nned t~ fJenc e.,Jt:u..,lt~ bflut.h t~ the' !~ur~C! '.fl aemCtS and liT~nt c?:-:u."11t1ep. 11) which we art lLa~inr the. tubtrculnrh ll"'f'ulH.y !ltupr. reached lie t"dar. t think ~t COTf::'! nrr~.~~inr we talked ab,,,,t !at-ur,!r.y am~ '!.~~lc! ,ive U~ the Decenary 1nt"r;ttti 'Z1. If it leems necf'!!!U'y CUle .e arc: 14 .,.,u~ 'le '''"r mr t:" mz.lr;(, an in!ceet!"ln Ti!1t !n d'lUl:t latu ab"'ut cnnc1t1-n~ 'it may ! a,.ur.le tr",r. your If in ' ttrr t!:Clt Jlilt,)OlP\cl. r'~ I C&D t Y"U lIecure U~ in t~)(: cb ir:"nrz:l&ti':'::1 ubt al-"'ut .. treJt 6 !'ource tru~ted 1l-W 1:. !8b(:!!tc.-r, "C 1 e 'm0Yn bt~1eve t'" )'!"U ~E'C.:rf t~ '.1 !:;.!'~ra:~t ~ C.nac!a" J"Ihr.s-La~vtlle t.v~r,h tr. !J:!"t.:., tn Alt.s~ the as!)! tr.nt tIJ Dr. T CO&l1 St.eVe%lsor: at wb\ch I he:ve r.lc.u t.... .ETerE.l ~UE;!t'~n! w~~ch I =:'1 Thit. (1) Dr. GrL~a:t tHd n"tta.keuJ) .1th y"\:,,n Saturday R~~!, Medical J.,1ree~r of ~at!"D&l F-TE:"'~r1p.~, ~,~~1:ltru.l &t.~wt 25 ~y!1c1a~! in Is~ h i 1 e r ;terf !tl"~ lr~ ~r~r.!Ft~nal ':'ur indu::ttta ~rbL~l.&t!~D l heut .~ich h ~terl&l. he a~ Dr. Be bal ~11crell, ledtcol ~irect~r ~! Jl~inum C~=~~1 ~r th., :5 c~~!e! ~r .~rcpr1.te literAture for Ca~kd.t ~re en. ore~n1&\ng. Do y~u ha~e He c~uld u~e .yo~11f" of ~ur Dr. Tndup.trl&l Setlt~ ~.rtel ~~ d~ ,"U tiSh to I~-ly ho.s'y\t~ them' (2) Ir. C. I. ICGa.. , tn "r A~~~t?s. CU , char,.. "r Incu.st:le.l Pelat~'D' t! t8teres~ in havir;~ hlth Canadian J"\hn!-~ville, edUC!t\~D .aterial for .duceti"\~ work with educ~tt~n thE1T~m~1~yes L~C n~~ want t"\ in A!tcF.toa. !her h.v~ ~c~~e quitt turn ~ hpDltheduc~ti"n. ' B .antp,d .etiv~ in Barety t~ ~ 8Ur~11ed "'it', t~ hc.6.lth ed...cat~"n Qll.tf.rtll ttlich 6 turt :'t~0l cCln tE!'ld him' It n~tt .hat de .f. have: aV8La~lr. ~ ,.,.,U hevt Y"'U .h~ don&' I r.1~ht alp" E l1ter- t~" t l'r. tl.cGn rds~d the :;:UQ!t c':In ab"ut nur!ir.c !emce. lent! "D He ea1r thAt tht" h:nrt't!i ~D h::.d \)u:, '~Ten !nFUTbnce awp ~urchased. thee t,.Pj!;, t tbf>Y ."uld hut ru:lJ'tling 86TTice w'e::. t..'le 1 E~l&!l)ec ~~ht .e ~~~1d~ n'I:Tpinr 8~rTice .her~ i t h av::tlar'le anc! t.~:.t .,uld I).,t nece-uarl:y rolla. the c.,ntract.. You nerha'r'l len.,. or the bac\o:f:r~una t' :_ and ,..,u may ~ 1.11', tf) e&y 1"\!I'ethln[ tf.\ his. or t."l. tn 11&. . e r a r c':)nneeU"'n the t ., .Hob t~e mil)e! we nursint 'ernee, I pve In!lure In Th,tfoTC, 1:-. '!ial o,,'eea the 'l. C. !l&i t.h ~r l)alDe' tL th~ kll Mt"lein!!e' st, ~1~!cwkere.k.~drewJ"hnt.,n, or .Tl)bn!"Dt~ nne.' She h "lazmiDg t" ca.ll on atur. (3) Mr. Ivan ~ab~urln T s~ll arrange t~ ~ut h,1.~a ~l snot h1entr~rtea~ttte~dt\ci nal U~Bturol~l .otli'Dt.ra~n1h1ettn,~thl ! ls'tt,e r~u-t am !n doubt as to ahat y~u ~rertr t"\ do ab.,~ ot"ler heAlth literature. anwld 4, _ . . --..----...-~.;..;,.,..;.,.;.,...:.;t ";;.;'~~';.;.:~.~~- 144 947 orts 'Ap Jpes :idre fana e de an. . reon lice, odait nent6 ee du iques, :ttanl. l&e et Bantle )mmes :aetleUr lrnoU$ :~f:. C!alllal C)SC! qui un de ge et Ie 1091 Novetnbre 1947 7 . Un programme educationnel 8UJ' la prevention du de 1& tuberculose tra.vail dant les et une am6Iiomtion des conditions hygieniq\1e5 uaines s'imposent. BIBLIOGRAPHIE 1. DBSMJtUJ..S, R'I RoUSSEAU. L ... GIROUX. M.t et R.CKARD, P. Laf1("z M'dica~ 8: 217, Amiantose et tubercuIOM pulmonahe, . {mars) 1943. R., et GIlt.OUX, M . Amiantose et tuherculose 'Puf- 2. DJtSMSULES, e, UDGl medical, 8: '-27, (mars) 1943. , J. WiUiam, 3. L~lNUZoAn.airA.-J., McCoNNtiEonLto.,f uWbiellsiatom. dJ.u,steOt Df't2hBeNluLnge of asbestos Effects of the inhala workers, Tid: Apart n 166' ; Pu.blic Heokb Reports, 59: (ja.n",ier) 4. 1935. DONNJJ.t.L1C', l.s Pubnonary asbestosis! incidence and prognosis. icology, 18! (avril) 1936. Jou.maloJ IndlUtrial Hy,ilflf! aM Tox ., S~y of a pO!1P of employees exposed to 5. MePlIEETaaS, S. S l.$hest05 dust, Jou.mal oj Indrab'ial Hygiene and Toxicolo8Y. 18 : Lv. 6. favril) 1936. LANZA, A.-J., et P.Dl.EV. Frank G., Notes inCdites. Symposium. 1941. u~rculQ$i$ in Irtdusz1Y, Saranac LaborAtory Tubercul08ia Association, p. 199. 7. T pubIi~ par The Nation.o.1 Prank G Asbestosis. Canadian Journal oj P"blic H,altb. 8. PEDLEY, 9. 576. (novembre) 1930. Tull4!rculO$is in Industry, Saranac Laboratory SympO$i\1m, ion, p. 50. 1941. public par The National TubcrculflSw Associat he Problem of dust phtisis in the granite 10. HOFFN.Al't, Frederick L., T stone industry. Bulhlin oj tbe U. S. Burt4u oj Lobar Stllfisrics, n" 293. (rnai) 1922. George M. WUEATLB"l". M. 0., Assistant Medicdl Director, Metropolitan lfUurame Company. ...~I , .. f . , , I ',j OS/22/95 16:53 TX/RX NO.1824 P.OH