Document 0q1DGgyOwrkVxXYyZMavd7Kan

Threshold -unit Values f This defense is -vuiti premised end goes tr.jsiy: *The .S* o* ms.-iuf auc-r.ng .ndus.ry wax deluded ov reliance on the Threshold 1.-n.- t Vel.ca .1. chat we assumed that me cor.xtruer:or. environment differed .tarXedly from the mining and manufacturing environment m. that the former workers were exposed to admixtures --- --'w cf asbestos while the latter were exposed to 1001 esoestos. we further assumed that the TLV's established a level ef ti to esbestos duet and that an insulation worker, whom we considered Z> to be exposed to leee then 5 million oertleies ef due- ten cuoic foot; was, therefore, not at risk to contract disease.* a. history of Sstablishstent of a TLV for Asbestos The 1335 Metropolitan life-insurance Company study conducted at the behea* of e law suit cl a cued asbestos industry under the benign guidance of Dr^ -JldflitJbout which more will be sal: belcv conc.'uiud that the 'experience an far does not warrant an attempt to define a standard of dustiness for asbestos I The U. S. Public Health Service was reguested by the health and compensation authorities in North Carolina to make an engineering^! and madleal study of tha conditions in that etata's asbastos textile industry. The results were published in detail as a Public Health Bulletin in August, 1938, and in more concise form in the American Journal of Public Health in 19 39.*", 9'0' 'S`f In all, 243 dust counts ware made to measure workers' exposure. nie counts employed standard methods for that time, and all particles in the air were counted, not just aebestoa fibersn>* unit of measurement of airborne duet concentration was million particles pgr (mppcf) , end the maximum value observed was 7. 3 rppef. Medical examinations were made of 511 awn and woman representing practically all of the employees at the tiaw of the study....The three factories atudiad had been in operation < to H vaa.t. V||W n mnmrhi tlifart tudy, approximately ( NjA* *150 workaxa were replaced bv new ones with little \ or no asbaetoi experience: ka a COnseguance, \, --thara was an abnormally large percentage of ^Jttrkera-wlth .see than 9 veere^ .enjoyment in w^'|tho aebeotoo textile industry and an ' --11----- Teas age, who had workad lO^eacL-BE. `adust re-. - --- .n- : ac: , .css thar i or.Iv Jt e-rs oi exposure. and year of expcsure. T.e Public Health Service The percentace of pcrtor.s with aabeatoall greatly with increasing length of employment. ... (A] latest three-fourtha of the workers mpiyyeH tn- e^re than li years have the hhrly stages, at least, of a disabling disease. a^beahsiiTj iinca- tXese is no satisfactory way of locating and examining Mrimi wha draa out' of an industry because of disability incurred therein, the percentage values of the foregoing tables are necessarily minimal evidence of the prevalence of asbestoais -- -- .- l*|J per cent of the 9 former aabestos workers [w.-.c had been traced] and 378 men and women employed at the time of the study in three asbestos textile factories had asbestosis. (Persons who were not exposed to appreciable quantities cf asbestos cist nave not been included ) The .oon-exposed persons were office workers"anJ other non-production personnel and applicants for employment. Eight per cent of the 178 workers employed at the time of the study had asbestosis. This does not completely represent the incidence of asbestosis because about _1S0 employees were discharged from these factories _15 months before the present study was made. . Many of the discharged workers had_asbestosis, as the reports of Doctors Shull, Donnelly and McPheeters show. Although an attempt was made tn x"ir.e as many as possible of these discharged cases, only 69 could be examined, <3^peraons_nf whom had asbestosis according to the diagnostic standards employed in this study. .The investigaters went on to estimate that another SO cases of asbestosis among the recently discharged workers had 'escaped observation*. In other words, there ware 30 eases of aabeatosis in the factories by the time they were Inspected by the Public Health Service, and an estimated 93 more aebestotics had been fired by the still owners shortly before the Public Bealth Service conducted Its survey. The wholesale replacement of tenured workers wae so dramatic that it resulted in the average age of the workers being lower then any other group previously studied by the USFHS. 3; -.m. long- term exposure, eupec.ai;, :r the least d-sty process*:*. the companiea wiped on nor. of tr. data base, the Puaiic Health Sr"ice needed In order tc develop any good doie-responae dat or. axiestoaii Only 5 vcrxrrs . ; stud: who were considered at r.o* of disease .-.od oeer. exposeo to level* u-nvde,.r t ft . v yuan. Nvne oi the 1? Qe rtons exposed to dust eoncer r rs 11 or.s below 2. Billion particles per cubic toot had a "" case of asses tci-s. although, as a mattar of fact, XT' only 6 persons tad beer, employed more than 5 years Nldv There were 3 'doubtful* or borderline case* of asbestosis found among the workers exposed to 2f to 4> mppcf. Despite the oaucif- of data or tr.e risk ano.-.c workers exposed to less thar /'l 5 wppef. a tentative threshold value for asbestos dust exposure lof 5 mooof was designated. Despite much criticism in the literature, / this value stood as the recognized TT.V in the United States for me next 3C vears^ although it was given short thrift by some United State /' and foreign manufacturers ^ ' The Public Health Service investigators were assigned the difficult task of prescribing a limit that would be safe and demonstrably attainable with available process controls. They cited e 1935_Perm*ylveiU* study^^hat shewed that incidence of laefaeetmaia^laereaeee with the concentration of airborne dust and (that found no safe threshold; In their report of a similar study carried on in Penneylvania asbestos textile factorise, Pulton. , noolev- Matthews, and Hcutr found that 8 per cent f of the workers exposed to an average du*t^^*^C~ / .-'Concentration lj`11 <r^1 P'*** '~"K<" / 'w foot had asbestos!*-: 22 w: lent of the *7 mi'' ifT* \ P12*ir ~^r""P' ">< n?* the * million 'a-group had asbestosis. , ^ * between the Pennsylvania findings and the snppef threshold sat by the Public Health Service study was not resolved in the Service's report. Nonetheless, the Public Health Service proposed a 7LV based solely on its own health and engineering study ignoring frhe_PeiinayIvanla study an* sfnilir- Because of the importance of the problem, it seem* to be desirable to use such data at are at hand to define tentative safe working renditions that may serve at standards for the guidance of factory managers and "rinsers until more uta are available.... Because clear-cut cases of asbestosls were found only m dtist concentratioee-->cee<tine i mill-.an -- - -- particles par cubic foot, and because they were not found at lover dust concentrations, 5 aillion particles per cubic toot may be regarded tentatively as the threshold value far asbestos dust expoturs until better data art available. In order to find out the levele to which asbestoe dust concentrations have been reduced m practice, an engineering study was made m an asbastos textile factory m which dust control equipment has been recently inetailed. This shove that means are already I available for reducing the dust exposure of a raa:enty of asbestoa textile workers to less than ; n'.l-.an particles per cubic foot. 89 . .... The investigators wtre optimistic that no new cases cf asbestosis would appear if asbestos dust coneantrations in workplace air wars kept below 5 meoef--and followed by describing 5 nppcf as * "tejv^^v^^^esho^d^ that could be achieved with available methods of dust control. This grievous and unwarranted conclusion suffered from an additional limitation. Lika all cross sectional studies, Dreessen surveyed only the working and less than half the Aa generous and 171 feum-'r-* * Trcosaan's tentative dust conclusions wsre to the industry, his paper was not Joyously embraced.by all. Wrote Sumner Simpson, President of Jtaybcseos- Man` ttJLn, to Asbestos Hagatlne on March H39; I think that whan we get through with our Saranac investigation, we will show that this paper it considerably distorted although he does sey at lest that where the air can be kept down to S million microns, thsre la ryp dancer and t can tell you confidentially, but am not willing to make It public, that the j* mu vi S mill tan mlerang with --*ltl*'* * T am not willing to Start a eqptrqyg'-fy-w< ww my competitors.91 The American Conference of Governmental and Industrial Hyguencsta :f of total duet as ths maximum silovable concentration standard , standard/sadly ^remain'd in sffact for mere than 4 SF fc. T'.e IC -j *- As L t-s tcs- - F iar. i Exposure Mytr. Protestations of industry apologists notwi tnstsr.dir.g , ;n thesis that agoestos insulation manufacturing facility wcrVe-s are exposed to irtually pur$ asbestos and and product users ta adnis---res is pure hcjtu^^JEotnmon sense dictates that plant workers wnc are ergaped m production l*i, processes t.-.c arc result c ' which was to produce a thermal insulation product composed of 159 asbestos and 951 magnesia have a kindred percentage insulators wno apply these products. Common sense sside, the early mveatigacors unanimously agreed. Funner. 93 6 6 89 lama and Creessen all found manufacturing worker exposures to admixtures of asbestos dust and other dusts running the gamut from 1 to 1509 asbestos dust. As observed by Nicholson regarding the inherent limitations of Dreesaen's approach: * ^ The instrument of choice is defining asbestos sir concentrations was the ^ginger in which all particles having diaenaionU^jSTater then ore ^**hrcounted, including many noa-esbect particles. Estimates were made oj SAe (rubber of asbestos and cotton fibers in the samples. The percentage of fibers ranged from ^*9 in wmsjiiag to '7* lin c---a--r--di-n--g. S*t i`n~ tviit-i-n----o- and/\ /-4er>**c. TO is it m cruanlnc ooeratione. 14 *. Th* Dr*n &nd ACGIlTVe*otl*rd* rvquirsd th counting of ell atmospheric dusts including non-isbastiform particles. 92 $)9 94 It has been stated that while work practices among insulators remained fairly constant between 19*3 and lift with few, if any, controls implemented, insulation awterlala probably contained twice the asbestos content in the prior^decade 92 e. me TLV is a Safe Level Hyth r>"7" t While the asbestos insulation manufacturing industry prior to 1917 conducted no research to determine the levels of asbestos exposure encountered by insulators 92 93 , they in retrospect contend that the TLV of 3 mppcf_was presumed to be s safe level beJjjw which-4X*aass did not occur and that they assumed Insulation work created exposures hal^waaid level. At 102 : Sot a Silt Levtl" Thrttl-.cic imit v;u are nctfin# *iow wh : or. f.aae I (_'.t jrar. t. ::petaf___ ~ Threshold limit value* ar.d tha.r p.-he-.. t krs . Max.mam A^lowanie Concentration*, attampted tt aeu or.ly / ur.i.rn concentration of a toxic substance was tolerable i oVi iCii tv o f case* for forty nour weeXs for a werxinq l.fetime. Tne TIV-kaC standard lonored peek exooaure coraider*tior.a. 9" * die preface to the 1948 ACGIH MAC list explicitly declare* the liir.i tabiont of suen standard*. While it will doubtless be very advantageous to have what .might se called permanent or standard .maximum allowable concentration values, it must be rne in mind" tnat all our values at* the present i tine are fluid and subject.to annual revision. They should not Jam adopted aa_ fixa a nr'ec^~ values. but merely a* guides "Sfl` iaaiat ua itr" oerTning mora or leas - wg ^nf** ` '~*`|, It must be borne m mind that these values are not lndioee of toxicity and are not intended to |approach that value.Accordingly, the comparative /toxicity of these compounds ga"n?t *** hHw / on the basis of fgaerical Tfffjf1"" allowable ' concentration value. in their reeponee to drugs and hererori. If 11% 'figment of imagination to think that ve can set down a rise limit below which h*r* ii fifTTi* -- -- and immediately above whiyh.there may be * high percentage. oi ca'adl Of 'poieoniag among Orate exposed. with these facts in Bind th* Committee has set values liSlUV wbi r-ft, 11 is fair to expect reasonable protection and above which it i* reasonable to expect that can have occasional cases of poisoning. Neither the scientific community nor the a^eitos industry- considered adherence to a TLV to constitute failsafe assurance that dis*ae would..not occur^elow auch.a__level. The results of e survey of the combined membership of the ACGIH end the American Industrial Hygiene Asaociation, reported in 195*, which, inter alia, sought tp quantify the- degr fit in TXV'a are revealing: I- C7 ^ i' iCfdwfidenoe loot ' lot sot Less than )0t Qualified Humber of Hapllae r a' Total lit ? AL 102 # *1 * n 0 ij With specific reference to jssli roe. the captains of met. industry were not .r.sled by the asbestos TLV of 5 rapped. As was so eloquently stated by Vandiver 8rovn, Secretary of ' Hanville in 1947: , Sc far as I nave eveq0ten able to ascertain, no i/one can state with certainty whfrfa>s-the Taxman ( a'f : awa~nl| I: tor asbestos-tfbst. I am certain study has been made apecificaiiy directed toward ur|iir->ii.iii; >. f-.QMra and I question whether there ]/ ''exists sufficient data correlating the disease S to the degree o* ||""e:r td Warrant .y pitaraunj that will even approximate accuracy <3.B. And the Phillip Carey Manufacturing Co. was told by an industrial hygienist consultant in January, 1963, upon completion of a dust survey of one of its asbestos manufacturing facilities: "They (ThV's) are guides for the control of health hazards - not fine lines between safe and danocroua concentrations.*99 Assuming, for the sake of argument, that insulators we exposed to lower levels of asbestos contaminanta than manufacturing employees, concern over the effects of long term low level exposure to asbestoe is not of recent vintage. In a 1947 unpublished Dust Investigation conducted by the Industrial Hygiene Foundation at the request of the.Asbestos Textile Institute, the asbestos manufacturing industry was clearly apprised of the inherent dafigjaw/-) nf the Prsessan^naplrad^rav^and the potential harass r.suit-lng from long^tsrmlowlsvgl_exposuret The maximum permissible dustiness for asbestos is commonly taken to be 5 mppcf. This rsprssents good attainment in the duae control program. It is emphasized, however, that dust slimination to this extent deajpah.positivlx_^hsure|hat no ssbeat^rfs will- dsvelop in some wgBtfrOftsr JU-------- ---Burkina 11le. (greater than**n'-J5^eV.^f,. aydance is-obscurs on th^a p^nt. 100 ' She IKF s tudy'^j^ice^T^aa" predicated in suhs ijTTi al part on the limitations of the Draea-p- -- 1. J*4hat is ths sxpeetatlon of asbestos Is In odd workers who composed the subjects in the uaraa study, thara wars abno/mally 'nr jj1"* * -* hfta *TT*ir1 **--JA-ssase IW iwacilcsliv ovl* ZD^ TKTTarct*leriowely affaetsd ths Conclusions that could h_toea<m^001 MtT.CC sc : . J . C T. .r.zrr.z c. : J-.c.latle dot* not permit com i-cr. ppcf :s t nj^pomp.-,; - - fct l- ag r has epee ( t.rr.: : one s tetter estimate of safe dus t. - s; . ' ' ' unfortunate.;- while toe fri" proposal to conduct such a long rant* study wa* proposed to the A?: ..-. 15 4 7 . *J* it vu r^etted :r. .5 46. ` The soier.t.fic literature is replete or. the 1951'* a.nd early I960'* with references to the fact that TIV'e do not srov.de r;o:d guide* belowj-hich pi.sease doe* not exist. Sr. Kenneth L"-.c.-. m 1955 expressed t.ne prevailing view inac/iV.bividuai suscept it i: ity"~'l --y V' ' W ar-.d^'peak expcsure&^renderec TCY's valuable ne'iU,,y"ai uef.tra.--Inc not specrTic uardstipr.s - 3y January, 196 3 , the i.mtatio.-.s of the TLV were so well established that the ultra conservative Committee or, the Pneumoconioses of the Council on Occupational Health of the AKA (whose 7 man membership included 2 fulltime and 2 parttime consultants to tha aabestoa industry) was moved by mountains of data to acknowledge that "brief and intermittent exposures to extremely large amount* of dust are capable of continuous exposure to more moderate. eo..____ i." i02? ^ny lingering illusions about the total efficacy of the asbestos TCV were certainly shattered hv the late p"-" issued by the Cossaittee on Occupational pieeaees of the Chest of r^e American College of Cheat Physic!".which ircluded, inter alia, the observation that: yjf There is no op for asbestos ' dust and the best evidence for this ia that several governmental agencies bare recoaseanded ^fiflP, "ft aaheetaa particles. (ay fny length! peT cubic foot of air as the a.s.e.> some-Industries have a4SB*d> 1*1.000.000 afheefpe Hhee- r>f T[ HIAVHhr and length per cubic foot, and a third group of hygiemstf considers;a njf ^Q|Jpa ana-egeai parT)f]., per cubic laalTim^safe 7 im 1 . .7- ; AL102 J u I ~ . ic a ir#jrer.c Value wh: ~n ;sirred gr* rer.rhd p-e* exposure ccr.ceits *nc fa.Ied to calc-late me effect! of lore ter-- ;xso6ure produced a continually increasing number of Ci: and soaw of disease m one allied .-.a.-.-insulating the l?9C's"`" and conjugal dlseas* < tna 19_70^a.10ir - In addition to knowledge that the TiV did not ensure safety, the industry was acutely cognizant of the fact that it was measuring the wrong thmc--tota^^^rather than Thus, Va-diver S.-owu cf Tohns-Manville in his 194 7 Saranac soeec4^-ntnd tha ATI or. r--.-r.erau occasions discussed trie need to count fibers _rather than dust. an unpublished preliminary report to his industry sponsors, Gardner f* ^ advised that the lnnBratharthan he._ahgrt fibers were disease inducing^ and urged the dust engineers to direct their efforts toward the fibrous material, ip the alr.10^* Concern over the adequacy of the TI.V prompted at least one major manufacturer to employ a dual measurement approach. :.n the 1963 Phi Oust Investigation it was reported that one large manufacturer (J-MJ employed a TLV of 5 mppcf for all^ dust below^lQ microns and 1 rrpggf--lp~ all fibers greater than iu^^ijrsns_ ' gg " * And Or. Wllliaa T. Marr reported the same information in his 1964 trti 79V .This practice was stated by the Asbestos Information Association to have bean uspleaented shortly after 19 39. d. Exposure levels of Insulators end Shipworkers daggers' historical analysis of asbestos exposure in insulators and (difficult,for two reasons! (1) Excepting the *'hrlaisc^ar?i*y survey? exposure level data were either not published '^notT <T4 noe accumulated prior to the mid to lste 1960'n C; Correlation |bhe!euw^ggne ftut CcPoUunt samples and modem 'iber anals-sis methodology is diff cult. 92 >: rs t.''**;:. c. tc . r.z+: : f- " .`.:,*r * 1 :&r. 5_ ^ r mi 1 . 11 ter oi :bi of t:hheo 19*5gJ 1? f/r.^Ard c: the* g mJs secuen: I y reduced ;* .-dari*., ~r~< . c\ - --. s;*.c4`^: 7*f.lud a near ci 2r: ;/*: m levels and in excess c: i> f/sl (Sj > in the: rctr "fir*t; the pouncing f applica tier./ `.as* produced a mean excess of 14 f/ol f$mnl at the personal and 8 f/ml fSm) at tne rcoc rncritormg s-auiona and the tearcut operation (nc: leischer in . 79C resulted ir. ip-nta t it mo personal -i-onitorin? station and 8 f/sl ;5 ram) at roar --uv ^l. Proc-ct r'e lancsite cg ritrrar.ee was evtr ac:t -i _h lv-_-.s apcroachtnc 7~" f 'r-J hrrr' -i 71 f/rl the perscr.al ^.i^riag statrgr.a respectively. The authcr'r. ronclrc-cr. that ir.ampulation ar.d ccr-mhutton of ill feer cf i predicts "within confined sparei*_mrnavy result tinr. airoorre asrer: r-r*ar rl* ang-.,'--. ceiling value of the TIA' un well justified data. 'Harci^*and^rtoak/i>.N,a^I971 publication to ccrpar* rass fibre in srinv.'d inr~~ 1 tier:'. peeresses =.-.d cy measurements found remarkable dust counts. Total dust rc-.-ti taken during remova^of sprayed crocidolite asbestes. re.tr a pipe legging and nelirrtan of produced near rc- re-.trat of 17,3 ftppef| 14.47 mppef and 6.17 rppcf, respective.;. . ? lust counts reported in an obscure L\ S. Navy :? = ; .yielded the following data* <\-- K$aii. i.- ...il Operation Oust Count-moped M toeu cloth __ afc.'fnsulatlon block asulstion block ^bloek ^"^WScjk^a^ilatlon' s^ -&P9**** coiSstiJnglftariboeoitn^s-mjaKnu. ;K- ,. 92.i 4.6 .ic : *t ft. . A r. . . c j t f Aiit1 * ~ t. t *r. r. e , r :. ...;. i u s "J 7t.~ '- r-.r:r Puc.ic Hes. L.- Bullet..- Ns. 2 p"XT7c t.A.-. i'.r' ::c. Washington ,' 1 i> 3S > F . Lreesser, Asbe^ > * - _ `_u /ft( :i.a ese.-.t TLV in the USA for Asbestos I.s: H. i. Academy science* .Jx: '.Hi, V. .?. Nicholson. :ase Study 1: Asbestos. - Th* TLV Approach Symposium on Occupational Carcinogenesis. Annal* oi tne N. i' Academy ci Science* 271: 152-168. In reaching tentativa conclusion* free tms biaseS1 ITo a baia, Ireessy ignored tha iaai.-.ina* cf Me rxeetrer_an^^^j!_ when they cites numerous tines; th# Brii-'n.1 irve jtigSS^erphas.;ed thac 'r'Sir *-* -- Ir. level ejhpes re* dlroesed to c un s - a-- -1 d: r r r ' r u - *u8 ,. thar that produced by lev t^ru consta_r_t_lv_n.cn Tx;;oui. Thui Mereweaoher argued, li-15 -- > ~ ` rtTTt.vslt ----- s, This^S^^rttTire.-.en: i or. object el; r>eiscr.ir ..*. 1945 as will s* d.scussed, infra. 9.A. See discussion ir.ira and discussant* Addingiey and W'lis , N. Academy ci Science* 121: 32i-6 (1 ?eTr~--1 * 92. Fulton, Asbestos it Fart II and Part III, Commonwealth. cf 'VftC> Pennsylvania, Department o Laoor and Industry, .iarrisc urr 12 1 91. Letter, S. Simpson to Asbestos Macao me March 22 , 19 2 5 6 S. u^Canra , A. J. , McConnell, W. C. and J. w. Fehnel, Effects c f tr.t Inhalation of Asbestos Oust of th* lungs cf Asoestos \ Publ. Health Rep. 5: 1-12 (1935) 94. American Conference of Governmental Industrial Hygienists 1.--U 95. Johns-Manville, OwenseCorning, Celote* Ccrp. (Phillip lare: Ravbestoe-Manhattan, Keen* (Baldwin-Eherc-Hill), Fibrecoari Corporation, Eaoi-Pinn*r in"tries. s'---'et I-dustries. Pittsburgh Corning, Ir.c. , Forty-Eight Insulation, Southern Asbestos, Rock Wool Manufacturing Co., GAF (Ruberoid) Answers to Interrogatories filed in "In Re Asbestos Cases" U. S. District Court for the District of South Carolina (1977, 96. "Threshold Limit Valuss for 1959", ACC IK (1959). And "j:;- wrote in 1955 that "according to the dose reepense ccr.cep some hasard exists with any level of dust exposure ar.d t-e 5>ymi avhiie level of dustiness is defined as that concent mu: below which y-KP[(e - -f--- of pneumoconiosis wi.: be kept trreptmHie lieits.' Hatch, 16 Industrial Hy^Xssie, Quarterly 30 (1955) -J~ 97. M. jSMfihjU tt* Weed for Threshold Limit Values, Industrie. Hygiene 0umrtertyT.7i274-271 (1556) VvJEMQ* Proceedings. Sixth Annual Saranac Symposium on the Pneumoconioses, 1947 99./''preliminary Industrial Bygiena Survey of the /hillip Mfg. Co. (pec. y-' 100. W. C. L. Keneon, Report of Preliminary Duet Investigation for ATI, IBP (June 1947) 102. Minutws ). <2^? K . M . 102B. r-r . -: , Nov. 19, 154? : ,jvu::rE Meet.nc, ATI, Jane 17. 19<6 J- ;.r~r..vtf of :.-.d Health 11: IPS '15:;' . i'.onal Health Archives of E.iv.r::., , 102C. Co.t.t.ittee or. Or::;at-:ns 1 Diseaser of the Chest, Report, Asiestosis, wisoases or the Chest 45: 107 (Jan. 1964) 102. In a letter dated 7-14-59 Or. K. W. Smith, Medical Director of Johns-Manville to G. H. Brewer, official at Johns-Mar.vilie Pittsburgh, California, plant. Dr. Smith decried the fact that of J01c^__service><^j^^iaa^whose medical files were reviewed* Lli sr.swet resit:.vA. evidence of pulmonarv disease. Smith uraef L-.e renovil of all atmospheric gust ::iitar"'ir.;.. 102E. Harries, F. C. , Asbestos 'Harards in Naval Doekvcrds Hvg. 11: 125 ! 15 6 S} 2- 102F. Anderson, et al, Nousahold._Cnntact Asbestos Neoplastic Ait*. Ann. N. y. Acad. Cci. 271.:_ilS' ----------------- 103. Minutes, Air Hygiene Committee: March 11, 1953, Tune \Z, 15S3; and March 10, 1554 103A. Gardner Interim report on Experimental Asbestosis at the Saranac laboratories (19 3??. 791. Marr, Asbestos Exposure During Naval Vessel Overhaul, Industrial Hygiene Journal 141_ 264 (1964) 104.' National Safety.'Neva Reprint (1972) 79C. Fleischer, et al-, A Health Survey of Pipe Covering Operations in Construction Naval Vessels, J. of Ind. Hyg. t Toxicology 2i > U94) ^ hv.' et al, ffileti;of- low tf Asbertcc. . *,, Ne^jngUnrf Tl-at MejLziS ri371-1279 (1971) ' lOt'J' Wray- Safety- Raviey,; 4 A J3 (Jan. 1947) 107.- letter,, Pelix 8t*l:n- fl,rsduata School of Public Hcolth, Oniv. oi. Pittsbubghl to l. B. Waters, Armetrong Cork Co. - 12-1C-CL. ' - 1&7A. .Tebbane, Balier, Cooper, Tabers haw, "Dust Producing -fJ.> POtenti^.',of ^Construction Material# (Unpublished, 1970) . 1071. Occup. irlaon of Bus-and isCcncentr4ticn* " yard, .Insulation Processes, Ann. 107C. Anon., Occupetionei^Sfaltfi'Jleserde - Release 127 (i960) ` - - . r'-- ., . />0X. 'Cancer Prevention Coitit.* llmlth, Hueper, Cartier) Archived)rof- industriiT Byelan* of Occupational Medicine Sr. US EKr-'- 4* . \ .. - . & --W - y< ,.7W't- X. Demy. N. ! 1961) . (.attar to the Editor, Z. Ama r. Mai, Aaso. Cl Sit 2. Bur.ter, :., 7hend Co., boston, .96?, ( 4 th feu. I M, X. Seiikofi, I. J. . Chur?, J. , and S. C. Hammond, The Occurar.c* of Asbestosis Among Insulation workers in the United States, j,-..-, H. 7. Aood. Sel. 132 135-Xos (1965). 4. hurray. 3. M. , in Rencrt of the Departmental Committee on Compensation for Industrial Unease. Minute* of Evidence. Appendices and Index: c.d. 34$5 , T4 96' Wyman and Sons, Ccnaon, 1907. 5. Auribault, M... Note sur 1'Hygiene et la Securite des Ouvrier dans lea filatures et Tissages d'Ann ants. Bull. 1'Inspect. Trav: 126 (1906). 6. Hoffman. F. -. , Mortality from Respiratory Diseases in Dust'-- C/ trades (I.-.orcanic Gusts) S. 3ureau cf lucr Statistics ''S ' Bulletin 231^ Wasningten, June, 1918, pp. 172-180. 7. Par.coast, H. X., Miller, T. G. and Uar.dis, 3. R. M. , i tcenslccic Study of the Effects of Dust Inhalation Upon the lungs. Arer. J. Roent. 5: 129-138 (1918). 8, Cooke, W. . , Fibrosis of the lungs due to the Inhalation of Asbestos Dust. Brit. Med. J. 2:147 (1924). 9. Cooke, V. E., Pulmonary Asbestoeis, Brit. Med. 2:1024-1023 (1927). .10 Seiler, H. E., A'Case of Pneumoconiosis. Result of the Ir.r.alatior. of Asbestos Dust. Brit. Med. J;_ 2>:982 (1928) . u! Beddow, A. C., Clinical Aspects of Pulsonsry Asbestesis, Brit. Med. J. 2:580-581 (1929). 12 .j Mererweather, E. R:r A. end Price, Z. , hcwOt on Effects cf Asbestc Dust on the tunes end Duet Suppressions in the Asbestos Industry. 3. M. Stationery. Officer London-(19i^JI 13. Me71ttie, J. C., Asbestoeis in Greet Britain, Ann. N. Y. Acad. Sci. 132> 128-139 (1965).' . 116. hereweether. E. R.' A., The Occurence of Pulmonary Fibrosis and Other Pulmonary Affections in Asbeetcs -oiker*, J. Indust. Hvs. 12: 19l-22t 239-257 |1930J .) "T*- 15 v- Soaex^fW. B, mary. Asbestos!*, Amer. Ray. Tubere. 22: 5 71 (19 3: 1C. Pancout, ^ knowledge of Pi with-Hoter on 14,3T<191 rgrar^. A Review of Our Present ' " .Roentgenologic Studies, tioiwi American J. Roent. ---------------------- Jlewiew of Pneumoconiosis, !7.*I..... pta#Hfc.II,. Amer. Rev. .-w W FOOTNOTES P<y. 2 (/ 'Zy' 1}. Stawart, a. it. , Bucher, C. J. and E. H. Colonan, Aabeatcsis, Report , of Two Cases. Arch. Path. 12: 909-916 (1931), IS / , ----=-- ---------------------- Wood, w. B. and S. R. C oyne, Pulronaij1 ',CI83s_U)ip Complicated S by Pulmonary TTuberculosis/ Lancett ji 9? 4 OJiTr^ p:r !Pulmonary Asbestos 1s"tleItas CclTlinHiJTAMI"r, Ri<adiological and _ 'pathological Peaturea, and-Associated Risk of. Tuberculosis Infac4oa, f S J Indust. 3vc. IS: 165-133 (1933)^ . m1 ~ ^ , . 22. Hemorandum oa ths Industrial Diseases of-Silicosis and Asbestosls, .' 3. M. loss Office, July, 1332 (p. 12). . ,>/' ,h| 23. - Ellman, P. , Pneumoconiosis, Part III - Pulmonary Asbestosls. ,3rit. J. Radiol. 7; 281 (1934). 24. /Wood, W. a. and S. R. Cloyne, Pulmonary Asbestosls, A Review of One ffundrsi Cases, Lar-cat 2: 1382-1384 (19341. 25. Lanxa, A. J.. McConnell, w. j. and J. w. Pahnel, Effects of the Inhalation of Aibestos Dust of the lungs of Asbestos WorXers, Publ. Health Rea. 50: 1-12 (1935). 26. Egbert, (1335). Pulmonary Asbestosls, Amor. Rev. Tuberc. 31: 25-34, 27. Donnelly,- J?, Pulmonary Asbestosis: Incidence and Prognosis, v-; - >-vvc^\. Induet. IYW. 18: 222-223 (2*35>. - .'?23,;*HePhe4itrs, Sv 3./a Survey of. s Crocp of Employees Exposed to : ,v.-Asbestos Pust'ii J.' InduetC^Bvu.-lli 223-233 (1933). - V'i- 'J- W' . ^ T- ~ - i- ' 2.`7laia<Aar, WC t /at.el. VJeslth Survey of Pipe Covering Ooerationa ia CcamtxuctUM&rva1: Vessels, J. Indust. Hyg. 28: -a_7a M a , r v -. .,1; -- -- ----------------------------- ------------- ,... ----- __-. - -------- ----- - - - ---------------- with Pleural , . Cuciflcatica amcAciZaifllkeion workers, Dsn. Had, BullC3: 255*204. -? . ' (iilJcrj -j -;4fe.: #**. ---------- *--;-- ----- ' -* ' 32. Sloyam, 8. Mi, Morbid Anatomy and Histology of Asbcstosis, Tubercle 14: 449, 493, 550 (15331. ` /v>^?3. r.Tiyfmm, 3. t., TWO Cases of Squamous Carclnome of the Lung Occurring i .-. ia Asfcaxtoalt; Tubercle 17s. 5-10 s >. 'ih\ of '. - '.V -R` J>- * Carcinoma, Asmr. terfc. VsJ(. A.', Pulmonary Asbestosls III: Carcinoma 1cosis, Amer. J. Cancer 24: 54-44 fTT35H nary Ashestoeis end JO/41934) ' \3; USSIEST sr/ltachtv Rrebaforsch.l f PaCtories tor the rear 1931;- 1 FOOTNOTES Pq. 3 38. lynch, and Smith, W. A., Puiaonax-' Ascastosi v, a Sepcrt chial Carcinoma and Eoithalia) Matatldcia, Amer. i-epe: W. C., Occupational Tumors and A. ''Thomas, Springfield, TUiTT ; C. 40. Holleb, B. 8. and Angrist, A., Bror.chioger.ic Carcinoma in AsOKTEiSa-wrSTPulmonary Asbestosls, Amer. 0. Path. 18: 123-111 [1942) . ^ 41. Bauer, M. Arbeit und Gesundhelt Die entschadicuncsoflichtiaan Berufskrankheiten Georg Thieme Publication, Stuttgart, (T5TTT -pp.` ro'7," isr-mr 42. I. C., Cancer in Its Relation to Occupation and Environ Amer. Soc. Contr. Cancer 25: 63-55 (June, 1943). Editorial, Environmental Cancer, (Nov. 25, 1944). Anar. Mad. Asso. 126: 836 Kennaway, E. L. , and Kannmvay, N. M., A Further Study of the Incidence of Cancer of the lung and larynx, Brit. J. Cancer 1: 250 (1947). 45. Cureton, K.J.X., Sguaaou* Cell Careiaeaa Occurring m Asbestosis of the lung, British J Cancer 2: 249-253 (1941). 45. Mereveather, E. X. A., Annual Report of the Chief Inspector of y Factories for the Tear 1947, B- M. Stationery Of c., lonoor.~ / January, 1.94*. - 47. Editorial, Aebeetosia and Cancer of the lung, J. Anar. Med. Asso. 140: 1219-1220 (August 13. 1949). ~ 48. Wyers, 3., Asbestosls, Postgrad Med. J. 25: 631-538 (1949) a? Stoll, X., Bass, h. ana a. A. Angrist, Asbestosls Associated with Bronchogenic Carcinoma, A.M.A. Arch. Intern. Wed. 88: S31-S34 (1951). ----____________ " 59. Bardy, H. 1., Occupational Medicine Wav Engl, (1952). Wed. 247: 4 73-48. 51. Zsselbechar, X. J., Klaus, B. and Bardy, B. 1., Asbestosls and Bronchogenic Carcinoma, Amer. J. Med. 13: 721-732 (1953). 52. Weiss, A., Plsurakrabs bei lungenasbestoee, in vivo aorphologiach geeichert, Medislnlsche 3t 93-94 (1953). 53- . Br--low#, at nl Occupational and Cigarette Sacking as racton m Inma'CanaeriMrAmi J. of Publie Health 171 (Peb.. 1954). ;. --:-- 54. Doll/- X., Mortality from Lung Cancer in Aabestoe workers, Brit. 2x ladust. Med; 12r U-M (1955). 55; .WegnerV J. C.", C. A. bad Nercfaand, P., Diffusa Pleural Nesothelioma>ad Asbostoe.Kxpoeure la the worth western Cape frorvinca.rBrit* d.- Indust. Mod. 2*0-271 (19*0). V. .-V " ->: AL tO 2 j :j , ? 7 c'tS rcormrz* PT 'tfit v.,J 56. Xosl, E. ET. , Asbestoals and Abdominal^ Neopl*r 1211-12 16 (1960) . iMCM'lj? - < i - * _ _ 51. Smither, W. J.,.Cil*on, J. C. and Wagner, j. r. Kesc Lh* 11 zr.at er.t Asbestos Duet, Brit. Med. J. Ir 1194 -1195 cl'f i . -- 'v* - * - : 5S. McCaughey, .i.l.E. , *ada, 0. L. and Elmes, P . , e,xp-,iur# to Asbestos Dust and Diffuse Pleural Mesothelior.as. 3r:t. Mei ;. I 21 1397 ( 1962). 1' 59. Eisenstadt and Wilson, Primary Malignant Pleura, 80 Journal-Lancet 511 (Nov. 1960). lo-a of the l 'it Eiaer.stade, Pleural Asbestos!*, IJ^Axancsa Practitioner V?3 01.952). Selikoff, at a_l, Asbeetoc Exposure and Neoplasia. 188 JAMAjjjfe. - t (1964) . *' Wadler, H. W. , Asbestose and Lungenkreba, Deut Med Woch 69:' 575-576 (Aug. 6, 19421 . 63. Cartier, Panel Discussion - Cancer Prevention Cormittee, 5 Archives sf Industrial Hygiene t Occupational Medicine 185 (1952! . Leic.-.er, r. , Prtmarer Dec.<7ellentumor dea Bauchfella be: Asbestoae, :::!. Gewerr. epa th. Gewerbehvg 13: 382-391 (1954) . Bo.-.aer, G. M. , Fauids, J. 5. and Stewart, K. J. , Occupational Cancer of the Cnnary Bladder Dyestuff* Operatives and of one Lung m Assesto* Textile worker* and Iron-Ore .Miners, Amcr. J. Clin. Path. 25; 126-134 (19S5). .66 Anderson, H. A., at al. Household Contact Asbestos Neoplastic Sisk, Ann. N. Y. Acad. Sci. 2'1: 311-323 il976r. 67. Sidnsal,J|., 141ia, R. and Selikoff, I. J. , Shcrt-Tera Asbestos L j, i/- Expo'aafs. And .Delayed cancer Risk. Presented at 3rd Int. Sy*p. ' on Det.'Arid: Prew. aCancer, New York, Apri 1-May, 1976. 4r *.*%!**. ?-' Dreassea,. "W. iC-. / ek al,-A Study of Aabestosls In the Asbestos -~t> Textile Industry*. PabTLo Health Bulletin No. 2a), U, 5, Public <V ij i:^e^de'elth' Skryioe, Nasttihcto.-. 'IT::: . ra* . SbYere./j2r Jt:**iSd^f*;C. Dreeasen, Aabaatoala, Ajeer. J. Publ. Healtn pf.TUJ^.'r ' - r -v Meperc. W. C., Occupational and Nonoccupaiional Exposures to tdlfcfAnn. H. T.'Acedb Set. 132: 184-195 ( 1965). .. 71. ''Clifton', R. A.,- Asbestos, Preprint fro the 1S72 Bureau of Miner. Minerals Yearbook, U. S. Dept, of the Interior, Washington. 72. Sander, Aabeetosla as Differentiated fro* Other Pneumoconioses , tlndttatjrlal Health 208. 73. .of^the Ministry of National Insurance ertor of Pectoriee for the Year vNo. 29 Industrial Hygiene T At 102 JO ; 7 7. *. - 1 3. State of the Art- The History of K.-.u-. vi; of Asitstcs The defendants contend that until 3r. Irvir.g teiikoff orchestrated the conference on the Si-logica: ''facts of Aabesiit -as^Uie New Yorr-_Acsdesty of Sciences m New vtr< City i.- October. Si 196 r%vt>.*Y ware unaware that insulators w:e at risk to contract asbestos related diaeases. Thus, they aigws, there was ac fut/ to warn or test or find substitute products prior to this conference as the stats of medical knowledge did not indicate e problem to users of insulation products containing asbestos. I: is interesting to note that Tchns-Marville. the inufasturer. lec-iei to inplace caution labels in^Septeaber. IHSTaithcugr. not on all ~jcts-l.^ariar to the October meeting. ln*"additicn, aitheugh Sr. ?aul Kotin.'Vcrrent medical director cf Jchns-Ranvilie, described the'conference ae a 'bombshell*, only.two manufacturers began labelling in 1961 and some did not libel before 1970. Sr. Selikcff actually first publicly presented his preliminary findings indicting asbestos as a cancer agent and describing asbestos diseases m insulators j^Tlune, 1963, at a medical meeting. The defendant manufacturers wr.o were members of the Asbestos Textile Institute were advised of end received a copy of Selikoffs paper at the Tune i. 1963., sieeting of the hTT Mr Hygiene Csanittue. I.' Ashes toe is . a. Ancient History The esrliast recorded ...a tori cal recognition of the hasaris cf asbestos, dates to the time of Christ. Jtnbe - trhe Greek geographer and historian (11 B.C. - scribed the dangers of weaving.1 ~ " er (li-TIJ *&), in mi description slaves, called asbestosis an bth writers stated that ofactura of handkerchiefs. waa ooeaoe, and that the f-Vaa equal to tha pearls of W- eo die uee of rasplrators to avoid r, is ^inhalation of tna dust by tha slaves. * Tha koeans instituted Os'.* */ PtTFfi " ---------- -!0 ALIUs.' JC "H the use cf respirator* in irltr to axiand the live* of t.-.es* laves, sue.*-, as one mighe oil a machine to keep it from w**rms out too quicXiy. The Roman* did net hav* pathologists with microaeopes or the sciu;..* c: reaiology availaoie to thee, out nonetheless they saw the cross effects of asbestos inhalation tr their workers. It is stated that Charlemagne's tablecloth vat cereposed cf ssbestos and it was cleaned by torch.* ,, The modern asbestos industry began .in the 1170' s, _and coeseercial production of asbestos insulation products was recorded as of 1874. SeliXoff and co-workers wrote in 1?5: Asbeetoe, as a mixture of fiber and sodium was first used as an <*'-' **. -ir iwm' and as asbestos about }_p7" MagnetH asbestos at a binder soon followed and air-cell cevening, made with corrugated asbestoe paper, was intpo>dduced in 1S8. These materials are still she, with others Initisl Recognition of a 3aiard ,y The first modem reports of asbestosis were in asbestos ^textile worXers in gngltad and Trance.*'5 One of these, Murray's /fut, was not published in the general medical literature, but it was referred to in e 1911 bulletin published by the c. s. \J sr's Bureau of labor Statistics (Hoffman) Bcffmaa said that the mining and 'dressing* of aaosstos unquestionably involve a considerable dust hazard. but the hygienic aspects of the industry have not ten reported upon. It may be said, in conclusion ae in the practice of Aattrican and Canadian l<fe insurance companies **"" MQrPT* am generally dSXXB*4-0B "account of the assumed health-injurious conditions of the industry. theft..there should be no further ' informal! igarding the asbestos indued*! breaches. including the sttnufacture. ee account of the * teuMeennesaes of asshbeesstoe dust as a predisposing eeueefef pulmonary tuberculosis. (Bssphaaia eddedl. "_ i Uoffge^s Department of labor bulletin contained numerous ?laaa otv research ah health ha sards In the growing asbestos industry AL 102 'TV*-' -r *' ?r.e -a:* ev* 1 jpr. us.-.r at.'c-itcii, * acerea..-.ac -r f. :e,::. sources, suggests -`.t - Ts-ji^c *: ' .-'edicsl c^r.sciera- * -- :ot., the sutract. "rffmAr: si I v*e* -".^re w^s . -. c-r, 'll so *. r 4"- ch ? C - r 71: Ccr.cril'c 1^0:^: z *c the rJ. S. jesic^ica! Survey,,- cr :the state Cecr?i4 <.e: j;;v future than it nas ir.*The- Also in ISIS, F_an^^y^^ar.d co-wcrkers reverted i. r in aba cheat x-iev*-o-IS asbestos workers. ' '*/ The.firet repprt of aabestosis in tbs iritisr. rei-ra. ,r was by Cooke. in 19'4.8 In 13 21, Caoka published aid hi`. I caaa, a 33 year oldjsesan.___ Ancther-case ^ a- .. aia was reported by, 3e; -in 1928. *'-------- ' wl - - In }9?9. Haddaw-reporter-rrmr ratal ts - average age ate death was 4:..** Ha also had fear "adva.-.r*;* : under treatment whose average age was 3S. XS 3.928-1939 Mereweather and^rice of the Factory lepartrat- In Craat Britain investigated the health of workers exposed tr sbastoa. The asbestos textile industry was a logical p.ac# to t^u,?4*Zaaft(fidfct^f^aLstudy, because these workers' exposure was t- of.vhicJS^; was fibrogenic - asneatts. eaql'-bfj relatively large groups r. fbr long periods' of tide, thus fetgTgbserve .the effects of pro'.lonee: < /* t- .-. aft- *% ... ,, i j ; rS: - fe u, . -- -A .vr // , Mezeweachsr and ?nre exa.r.i.-.ed .<! wori(ri and ?c_/.2 t_-.a: 51 (26*) had asbestosis and 2 1 - ar -ad "pzecurtive of _t. \*Bated on these findings, the authors wrote, ...it appears that the general incidence **te of fibrosis of the amongst noil employee ir. these sections of the industry is rather less than 1 in 3. or. e:li;dinc those employed jiri.tr 5 years-, rather less than 1 in 3. These investigators analyzed the workers' exposure by lengths of time and dustiness, of job, and summarized their findings thusly: hT.ile it seems necessary for ths production of generalized fibroeis of the lungs that a definite minimal, quantity of dust must be inhaled, the lower the concentration of dust in the eir breathed, the longer the lapse of time before the fibrosis is fully developed, and within a eartain limit, the higher the concentration of dust, the sooner the fibrosis becomes fully develcped and the more intense the involvement of the lung tissue. If this hypothesis is correct, and the evidence points to it, the practical inferences are of very great importance, since it follows that the application of measures rtsuiting in ths redugxinn: of the concentration of dust in the air in neighbourhhoooodd of dusty assbbeessctcos processes will cause, first a crest increase in the length __ of time before'workers develop a disabling fibrosis, and secondly, the almost total disappearance of the disease, as the measures for the suppression cf dust' are perfected. J. C. Mcyittie, of Great Sritain'i Ministry of Pensions and Rational Insurance, described the reaction to this report,'which contained specific recommendations for_iBPzavedjj^zitilation a.-.d dost' suppression.13 Ja*"" Under Section 7J of- the Factory and Workshops Act___ of 11 the Secretary of State issued a certificate ".to the effect that 'the manipulation of aabestoa and hb manufacture and rep*iz of articles composed wholly- ex' pertly of asbestoe and processes incidental ? thereto are dangerous.1 The section in the Workmen's '"""TVf*''*"** u?* which provided for the | application of that Act to workmen suffering from I j.ilieoals. wea-extended r.n .certain, processes involving exposure and in^S^l a^baatoeie waa*?aifX?~0Ctt^dthecaaipeasatahle dlaeaae waa defined as 'fibrosis of the lungs due to asbestos dust or thae disease accompanied by tuberculoads.' ^-- Aeeulstlpns^for ekb^jj^rentiljfcioo* dpst control, and housekeeping asdies ia asbestos plan** ware mtda effective on Marchl- i!3. urjft-' i^_ 'it- AU02 jo .'.05.- 0 '.J e arc t.r t turpi . . oc partly of asiestoi. Thus, it was reccur,. .u ; -..at .: .*> r.t- rectiury to o exposed to "pure* aaOaitoi ' Itr t-. o :.io.s to the disease. Mereweath.er' * finci.nra ware- -c s-rtly the American _ .: te fa tore 14 / At the e.-.d-of- ->:I. Or. vi. 8. Soper p-o.iinet a use retort of asoestcsis :rt" Connecticut, in tr.e An#r.-ar. Review of Tutercul r;is. *' Sotm? the dearth of American medical literature or asowstctus ar.c acknowledge,r.g the flurry of iritish publications or. the struct. .-.* wrote: lust as cerium other dusts tock their toll over a Ic.-.c period iefcre the med.cal profession awoke to tr.e true facts, so asbestos dust to a lesser decree appears tc be taking its toll without suffitie.-.t .^Tecosr.ittotu^jf^the fact or. the part of physicians. ' In 1915 radio loci i ts Panctaet ar.d Pendergrass of *~ ~ f|~*~ * reported x-ray abnormalities among asbestoa workers trey exir.u-.ei. ^-- They published "A Review of Pneusoconiosis* In ucd.t.or. to some cease mentioned above, they described asbestosis case reports from 1927 to 1929 by Oliver and by Wood ar.d Page. as well s. the extensive study by Mereweather and Pnre. progressive nature of aAiiMi:!: They noted the The condition is apparently prgS^sevan after "srevedSSer ar.d ?n. ltd Is that with .o,,l...ww exposure to high \ concentration dust fibrosis may be fully developed I in from sevefl a_j.neT. vara.. end result j ia about thirties vers . With less concentration. ! fibres Is may not be fully developed for 1$. to or liS veersT Inneistion of oust intugn concentretion results ia a more marked degree of fibrosis in a shorter time than when the concentration is lower, ((aphasia added). 'J `ther^case^regort^f^asbestoel^wae published iz lastgj^^aujLaroliasu^^ A literature review and \S( .their survey of the available liceretu 'i* -r'total of'172 eases of pulswnary asbestosis. inict^aod co-woxkers in Philadelphia reported two sore t8*s*wof': asbestosis in 1)31, one eftor only nine norths of expos. ^.csad'thiL-tutaors concluded by calling for further study. * " wi* -'t'.* ` v J.*?'. ~ - " * J> 1 TrW . "p'-i Plaintiff .".as not iurvvd the entire considaratl* oofy of medic* 1 literature In the late 192C'e and early 133' a. it to' ay that a plethora of case reports and surveys appeared ttore. - .V * ^------ ,^-5'e. The First in.u.ator Case* asbestos 'sawyer* (presumably one who save asbestos as does ar eI <t-.3..St*aMS* / ei l,,-* lo 31_ 30 ; In the July, 19 33 , Issue of the Journal of Industrial jtycisne. Dr. Phillip Cl Loan described the first case of esbestosis in an insolaattion wvcorrrk.etr to appear in the American medical literature: ------ . ) A typical lesiop. of mild activity, with an early stage of pulmonary asbestosis, was present in one of my cases who had bees exposed to asbestos duat for ten years; but the work, which consisted in coating *ead pipes, did.not entail axpoaura to high dust concentrations. 2 ~ - la a 1932 British Government publication, industries and _ proctsses in which asbestosis occur were described and included i~ >.tbe.-"saltlngr and repairing of insulation mattreesas composed wholly or partly'of asbestos and the-sawing of articles composed wholly or partly of asbrfatos...*33 In 1934 Dr. Eliman again described a case of asbestosis m ,ln^ilfpion worker in a paper published in the British Journal of lU^iology 23 r-Ia 1934y wood- and; Gloyne published e review of the first IDO isgjfc-df1 a*bestoia^-tfley'j'aa<^'aem^ ^Ameng the., <7 women ia their . rfdsrJ^gh^shd^&stfii&tceur*^**''*1^ <2 'cases) ... '$%*"" 'jf-V-i `<V*5 *" .and,all: of' thetwomen in this series worked at - " '' a thS'men.th* shortest exposure was 11__ ortad. seeing at least 3 cases occupational ** - k >& ?'-.--Ilstfir-.`4 ;< : * - *. ` tTjhali worked at 7! gashestoe fibers. ifbeieo- interesting '? wie^titavl V 1 AL102 * i -> Q t1 That evtn serious darnqs to c.-.e i no; in -or; -s with wr.y years of tolerably C3f::%;.c existence -s proved by such an example as that of <s whs was still ahie to carry out adoir.istra;. .e duties at a factory when nearly in-y*-**-! rjrr* r~ the dust r.ad c.-.--' a riSrisis ir.vcivi.., ----- .... . .n.1 re^...., of tha lungs. It is reasonable to consider the ..riper; cf tr.is case v.-_- regard to the ascestosis risk of insulation werXers. This case is described later in the paper as having r.ad `about 40 years fcle and administrative vorX) * at an asbestos factory, as of 1934. The authors provided brief, individual discussions for only a handful of cases. They noted tjojthat resulted from outdoor exposure_to asbestos: ...a van boy, aged 18, whose spere time during two ar.t a half years' employment had been spent ir r.ixir.c powdered asbestos in an open yard... ...a sen who had been employed handling asbestos ssttressas in the open air at an aerodrome. Again, one wonders how these exposures compared with the expoauree of insulators. Insulators *oryd - *. r-- times, but at othar times worXed in very confined enclosures where the airborne dust concentrations could "icrmulite* in the course of doing a job. The authors nsxt described esbestosii in *...a tiffla-aged boiler riveter who had served his apprenticeship as a youth m a shop whirs asbestos was used for lagging pipe...* It was net stated that this man ever applied insulation to pipes himself, but if he did it could have been only intermittently during his (several year?) apprenticeship for the boiler riveting trade. Be did worX in close proximity to insulation workers during his apprenticeship sad thus was exposed to the duet this work created. ^further mentions that two of the ashestoais cases carcinoma ef the lung. The following year r.e . ss.e: a s e p J or. ci tvc ;iii "f \ Insurance Company: n'Jt' In 1919, the Metropolitan Lift Insurer ea Company was approached by officials representing tha asbestos industry in tha United Jtatew, who wars desirous of ascertaining whether asbestos dust was an occupational hazard in their establishments and, if so, what was the nature of this hazard , and what should be done to prevent or control it.*- f Dr. lanza reported that the industry appeared to be 'guite unit formed* cf the hazard and observed that la many departments the"exposure was to an admixture of asbestos and other substances and m some operations, the exposure was to materials containing only 25% aabeatoa. Sr. ianza (later a consultant to Johns-Manville. recommended that the industry face up to the problem of dust control, and "sponsor stuAlaj cr. known casaa of asbestosis as well as studies on effect* of asbestoeis on the heart." e. . The Hazard Intensifies as the Industry Crows Si 1935,. D. g_;_gfrbsrt of the'Y^e-Onivarsity Medical Sc.-.oci "X* asbestos industry is growing.rapidly and 'that. as. a result, pulmonary aabeatosla will continue to beeoeie more important is teen from the feet that total world production of aabeatoa has inczeaaed from 96,490 tana from 1910 to tons in 1929.* -- -a M5 the Industrial Hygiene Section at the tMr::in fi!i.s health Association m Milwaukee. It was published tha following ysar.- Donnelly's ooen'nc rfrurki called *' "' -.-"e ; - '.e \eii_. implications cf tr.e rapidly rising demand for aaoestes procucta: That the serious industrial hazard of this type of vorX has .not previously received sufficient attention is beeoms r; tiers apparent. The manufacture of asbestos products has increased mors than four-fold in th^-iast 2C years, and hence, because of the j^edfer number cf vorXer* exposed, and the more ecuent recognition as s pathological entity of fie resulting pulmonary condition, tha subject of asbestosis has rapidly assumed greater importance. In the si Be issue of the Journal of Indusnial Hygiene and Toxicology, S. S. McPheeters cf Charlotte, Sort.-. Carolina. rape; on the clinical examination of ?1S asbestos tsxtils worxsri seer, at work.28 None of the worXers had been exposed__fcr.more than 21 yesrs. In his opening paragraph, tha author wrote: Mhile it employs a relatively small number of persons- the asbestos industry has had a remarkably rapid expansion and by rsason of the widespread and varied uses of its products which include 'matches, filter bads. paj,pts. rooflne. high-pressure joinTrhg, electrodes'? brake linings, clutfijj..rings and'insulating material in a great variety', the industry occupies an~t3portant, increasing and permanent place In our economic establishment. f. Case Reports of Insulators Contracting sbestcns Increase wi-h "-n icctlcuating lie uf tr.e Products As previously stated, asbestosis is a lung disease which is caused only by the inhalation of asbestos dust and particles - asbestosis is agent specific related to asbestos. Thus, any repores.-in. the literature describing an Insulation worker patient t,th--asbestosis or other asbestos related diseases demonstrates .could be and were being contracted by insulators. asSeat . rs ..-txetf* found in the literature describing 6^'-f >; v/ > -w AltO2 20 -:?8c Av AL 102 n ju ^8: I ' -A' J. Tl. ... V" V : n additi.n me r.i-urc.s esse, reports. , . jr.d up.deniolocica1 studies sbove discussed, genets' -;.s j- g editorials appeared . n the literature indicting itoeg-pr as a carcinogenic substance or an environmental he.-;-- -.ei^rd to c.v.. . ; and calling for test..no cr for development of s.tit: .-.e prod.rti or for expenditure of funds ' for dust suppress tor,. Table'll. The British Government was ahasjlof the United States Government m recognizing insulators as a group' it risk and taking definitive action to deal with the problem. In'" the 1932 Memorandum toi the British Home Office1' discussed briefly above, t.ne hazards associated with making and ref-a-.-ng ;f -tiaulation mattresses and ur.e saving of admixtures of ariestcs was cited. By 154b ir.sulattrs were mtc.::ro1l; -tic eligible fcr occupational disease workmen's r.u.-.eri-.p ' ar.d in a 1S64 retrospective stud;- of occupational t.seasf compensation claims for the years 15 3 5-il, McVittie reported '..'at the largest increase was .noted ir. asoesits insulation workers. l.n his annual report for the year ^l?ao . the 3rptish This! Inspector of Factories stated: y It is. very necessary to keep an "- fy 1/ for the new ease of asbes.tos in some manufacturing * or other pruuHSs, ror example wo hi?s cr buildings where-the.work may be undertaken by someone not fully realizing the-rct--of preventing cr far as' possible the inhalation of asbestcs fiber and dustT74 , In hie 19*9 Report, the Chief Inspector also described in detn. the hazards resulting from the use of asbestos spraying nach.i-es for- insulation purposes on ships and buildings, i'.nlin their American counterparts, the Chief Inspector observed chut me msnufjotiirar which leased such machines took steps to advise the- 'Insulators as to the dangers resulting fron. such .inTjCta proper use: * 1th unless proper precautions sf&Mbestos by means of these fnvvhleh they are hired s^of various insulation rse of training in their manipulation, lasting about 14 days, end 9idSt>tJves attend these courses from overseas aisgwl't" is from tna British Isles.7* [ixAX>- -l ' '-y.i.:-. "be Chief Inspector concluded by condemning the pract.'- of sr.-pplng'j raw asDettos fibre in impermeable ,,ags {a practice t.-...ed -i-.'rir, ^ British factories). j A. R. risher, tne.n ?ret i: of Johns-Manvilla, ian address in 195 5 befcre the Twentieth .Annual Meeting of the Industrial Health Foundation, praised the free enterprise approau). to industrial] iieai-1. practiced m the 'Jr.ited States. Comparing the voluntary but . enlightened attitude of United States industry's approach to industrial health and consumer safety with the `cradle to grave .I security" of Great Britain, Fisher opined I rt is only in cur wssterr. Civilitation that real progress has been made. And the greatest progress has beer, recorded in the United Crates end Canada. Perhaps there is a definite reason for this. Ours is the Riddle approach. We do net leave the problem of the nation's health entirely to the Government. We do net leave it entirely to private groups. Nor do we neglect it or merely pay lip service to it....Our approach to the health of the nation is different from that of England. Ours is neither a Government controlled health program nor one dominated completely by private enterprise.... [PJrivate industry promotes the well-being of the individual. Indirectly, we have our so-called cradleto-grava security without the heavy hand of Government....flIndustry today is directed by enlightened professional managers who realise their obligations and responsibilities to their employees, customers, stockholders and the public. * A Fisher directly addressed himself Ub the question of meus-rv -r-e--s--p-o--n--s--i-b-i-l-i-ty-- to the consuming public. `Every effort is made nowadays to protect the consume^ with safer products and better meuiuds of nandlmg tnem.* Having touted industry's snlightened attitude toward the health and safety of consumers of their products Fishsr comparsd 1955's attitude with the pest. Years-, ego industrial research was unconcerned about probljlgw.ofchma1 th and safety that might be involved ,."5 y J. 1 "V^WfeWnBflfproduct was developed, 11MiTKIf'; Today our Indus trial .3'"r; .* svs.-.***'' yuvTi vr. every health j&inalttsd uponbefore ' Sejaglle...h...m....e...n...t.. b. y. IOM C01>4fl.lM Of. research 9:1'.' 'lui arganisstlon'y*kse'i*sols purpose* was the eliminetich of vwr ' % *nesit)i'hazards that might injurs tha consumer.* TAJ3I~I 3 * '7*'.^ The incidsncs- of asbastosis anon 9 pip* covarar* in the shipyard* studied was low, 0.29 oar c-- or three eases out of- 107*... -- rSinca each of. the three casee of asbestosis had worked' at asbestos pip* covering in shipyard* for tort man 23 vaan. i. a., 1* concluded that suen pipa covering la not a danqarous occupation. rurthartaora, only active workar* wara surveyed, thus distorting statistics by cne absence of worsars who nay have baan disabled due^ to asbestos related diseases. 2. back cf reliar.es by John*-Manvi 11a Dr. Kenneth 3Kith ha* tastifiad that ha had saver naard of tha riaiachar-5Tinkar'*ur-/ay befsra 1976. Clifford Schacklar, foraer In3u*triaI~Sy7ieniat f orTchns-KSr. villa, taatifiad in tha Bore 1 caaa that ha was unaware of Flalscner-Orlnker prior to^19*0. ~ If, in fact, Johns^Manville relied on Tier* char-DriiSclT? "they attarly failad ta follow through on it* racamaadatios* while Plaiachar-Orlnkar reconaendad that dust suppression aaasura* be taken to pravaat diaaasa in insulato^^^^MM^^Ktaa recoSesfetions war# laplanaatad bv Jahne-Manvllie with their own insulator esplsyee* until 19(4. Tha 0. S. Navy obviously did not rsly preatly on fleischer-Drinka la tha January, 19*7, issue of the Safety Kaviaw. effirial orp&b of tha Wavy1* Safety Branch, it was reported that duat levels in one shipyard insulation operation 'approached* the rtv and recoamende t- ware forwarded to all Naval operations to iJ^aseeat dust suppression essurss including: isolatloa of asbestos operations, in shops free other operationsi use:of exhaust ventilation! Instructions to workers ^ for' =f US# " r--e-s--p--i-r-a---t-o---r-s--.-- >(<This Safety Renew > 1947, Issue of the HIT Digest) . KS '-. c trot filW-eultltude of esse reports and earw A*'. ssrdsi; to-insulators, tha 1994 Danish survey f^a^dgyird insulaeors deserves analysis.31 & rsstil scfcar^Orlnker,' the Danish`authors, reco^ni uf '/;^`'i4''^A the.**t*hUhad princi^l^that ashestoels does pot nanifestltsalf clinically ~ A l fOr> j- ; *Tfr*T*f MSayatecia* T 43 L- 1935 Jl/nch; end. South of South-Carolina pubf i thv d raa Mb*'tc?:' ter. 3 cinoer :'la the R~u.-..... . - *' - ` The victim was an asbestos textile mill worker-, tu.no -rr . an uncommon disease m 19 35 , sod the'occurrence- of even one esse ef 3^. SI'** asbestssls with lung cancer was notewoe-tny .- '-;=" - J ..`'*.1 . Egbert and Geiger ae the Vale University.-! JOf Medic in*.^r-. ^.*7 # published another case report sf asbestos is withriungi'eancer .a V" July, 1936. 35 The patient waj a man who worked as a weaver an asbestos factory for IS years. He had to leave his jes w.ne.n be developed a disabling pain in hia back; ha died shortly afterward with lung cancer. In 19IS. Vg'-*^"p in Germany published a paper entitled, `The Occupational Cancer of Asbestos Workers'.He reported two new cases of ''-if ~--~f th asbeetoeis. in a 3S year old woman and e 55.year bid man.- 3oth victims were asbestos textile workers, scr; reviewed the cum, ulat-iSv.`1.e-6-lite-,,,r'atur"e and was the first to propose that lung cancer be- recognlim4 e an occupa><fnfl'' "1~rg asbestos workers, tabulating.statisti.es from all of tha earlier reports. finally, Hordaann. assembled the scant autopsy data or. usbcctcsio cases to reveal that an unusual* y w ; ph *-*r*`.-.r] cf thase casas l-ad Referring to Weed and Gloyne's report of 133 oases cf asbestos.*, he ..r-.ec tnat oi ii autopsied cases 2 -1T1: had. ' -- 1 cancer. In Germany, he knew of 11 autopsied cases of asbestotics and 2 of these also had lung cancer. In Baglud,...tbe Senior Medicel Inspector of rectories reported that e toter^fSBolAgeasee^df *,. iojj^jiotppaie of the lung had occurred m cord ae of 1931 (11.61).3' 1th Caroline reported U wi jjeeneer in a 50 year old .^fv. 7<>* *v '* ** ' IS yr \rt h% if 13 yttrs. ??* nuUsnarcy ./VJ. *'-- 'a ":v '' ' 'V'-' l' ^' t c: the li'.ss wa* sc ex:e!isivs could be positive.y determined. Tha author* ;v: l.tccat .re or. .an? cancel m asceatoeis, noting tnst ... s-deieo . _ r career v: th sabaatbsis an occup*-'- rng ' _ In 1942 . the ler.cC.hy book Occupational Tunora and Allied Ulszises was publiahed in the United State* by Ur. Wilhelm Hueper. Bueeaa had* becun his reaearch on ceneer in 1925 m Chicago. 3y '1942, he had established hex*eld aa or.e od the leading American authorities on experimental toxicology and caro^r.oceresi* with ------------- --* -- --. -- ---------- dccer.a of studies ar.d books or a wide range od sooitanoe? ud industry. Hueper assayed the evidence or eabestosu ar.d ii-.g cancer and concluded that the evidence was "suggestive ;d an occupational origin*. Ur. Huapar acknowledged that there ^aa not a plethora td rase reports of asteetosis-lung cancer but he drew an analogy to "previo.s experience* with other occupational cancers and concluded trat: *y represent the dirst warning od a sunsecuer.t appearance of large numbers of similar tumors od undeniable occupational ^tsilyyaattioionn**.. This prediction regrettably was, id anything, an understatement of the extent o the a&cestos-eancer prccler. Hueper went on to discuas medico-legal and social aspects od me problem and urged wide ranging studies od thecaneer risks od asoestes work: Asbestos is carcinoma of the lung is not included in any group od occupational tumors recognized by any country. The evidence presented -f sufficiently serious, and tha mnber of persons exposed to the suspected causative agent large enough to indicate a thorough and extensive clinical, statistical, and experimental investigation of the incidence and 'causative interrelation of asbeatoais and pulmonary carcinoma w Tw- Tha^dlyat cast report of aabaatoa 1 a*lung cancer in. Insulator* was rsportsd by Polish ay|<* Va^S heS both had worked applying insulation m. to: o*r twenty years, Tha authors observed that these i wers exposed to law ' that lanf ft^a Hew' aiflfrftTI T'*'* ^^mulstlve affect an T.- . ..'>K On January I', 0940. me German 90verr.mer-. :e;lired 'teces-.ct. or. combination with lung cancer" a coffrper.safcle cctupaticr.ai ine*s. ackn-wiedg.r.g .: -- 0 --, ..;.uer occur* ------ .-...a...-------:* of asbestosis as di as m advanced asbe* tos is . < * Thus, me citations of mis health hazard in the medical litoratere since 1338 by Norisojm, e: ar, risuiud in the German government formally recognizing this occupational disease within a period of S years. Germany's tradition of industrial disease ccarpensstior. ?a stretcn.es back to 1384 (German Industrial Insurance Act).* In contrast in the United States, Hueper wrote in 1311 mat 14 states m mis country still did not bold employers liable for diaeases workers contracted as the result of conditions of their employment. In 1343, Hueper was nolonger uncertain about the occupations. origin of lung cancers with ashes to sis. a* wrote the following in the Bulletin of the American Society for the Control of Cancer: Asbestoeis cancer of the lung is the most recent newcomer among occupational cancers of this orgen. First described in 1335, there are now 13 cases at this industrial cancer on record observed among asbestos workers in England, Germany and the United States. The letter contributed five cases. Inasmuch as the asbestos industry is most extensively developed m this country, asbes costs cancer oc the long has for us a special hygienic and tociologic significance. In tht itae article, Hueper urged thee industry take action to control occupational cancer end implored that research be undertaken and substitute produces be found: Industry should devote considerably more effort then . ^heretofore in determining the cancerous or noacancerous . '''/.UMaKn^Ojfr their numerous products which say be suspected ^y^j8fe|ejalL:tgrgur|ds In cancerigenic respects... ^TnOTS'tq^^hOttl'd.!ie serious attempts to eliminate all potsntielltf'-cancerigenic agents from further use by the development of suitaisle substitutes. ' .S, t' *'*. i'i/ editorial, 'Snvlronaer.tal Cjacr*, ;n Kove.-tnr 15. 15 44. editorial warned that The___ar.u dost mpoitan. .. u.. --.rut*;. ,,al car.ct-rs _s reprssented by occupaticr 2. c a.-. c 8 r elicited cy f.oc?-:rt- to ch.eau.cal and physica. scents in the course 35 regular occupation!... The egents Known cr suspected to causa occupational career are... asbestos. Hditcriau called 5cr a search for substitute products: 4 " 11 The benefits from such efforts will be not only' =.' the early detection and improved prognosis of cases of occupational cancer but also the prevention , of industrial ca.-.car by the elimination of exposure* * to cancengenio agents. _ cancer ... Treat Britain. Froa a search c5 death certificates of lung cancer in salea between 1921 and 19 38 , they found J with asbeatosis listed as well. They were unable to ob: satisf actcr- fii,".rses on the nuaber of persons occupationally exposed to fl; ajbeatos but believed the nunbar of lung cancers was probably . . T">. .C*v - * " - greater than would be expected for the number of workers exposed One of the cases they reported was a 'bcller and pipe asbestes coverer*. The following year the British pathologist Curetoc reported a case of lung cancer .with uchastocic in t '---.-jr. vhs died at one t -rie.. agorot 37.' This woaan had worked for 7 years in "a factory " making asbestos pipe covers*, starting at the age of 15. v'; 3v -.w g#-'. l-A- u;.-`if'y*a_c_a_*eatber,; Chief Inspector of Factoriee, produced cu -1 ^ sastisfcfdlF for autop<ff4 ^ aebeetosie in England frea -1. Ws .'sy v11 T' "'J - 46 in;bis annual jropore-for the year 1947. . In a a1 was contrasted with the incidence ead the general adult sthar words the expected' nuetoer of lung .... ..-T.TrfT 1 caafeers..iaf-a secies of 23$ would be (0.01 * 235) and instead, .. - ^ 7' - hence that ss many as lung eaneer cases m 33$ would occur If their real likelihood were only the ease as that of..the general population (It) la reacts -- lee* than 1 in r*ailiM: r isb*t-.:i:i cius unmistakably ar.d unvaiveringly led .itir papers. '? cancer poi :ed cancers. A 1949 Editorial is the Journal of the American Medical Association (*Asbe#toeja -d Cancer of'tha lung*) discussed 'A .Mersveather* findings.4'7'-* Tha Edi'torial citad epidemiological and experimental avidanca suggesting that asbestos workers wars at . increased risk of lung cancer. It characterized this risk as probable*, and stated that workers in asbetos-conauau.ng industries should ba considered at risk along with sanufacturing plant vcrxarss Since some 20,300 workers art entploysd in tha asbestos-producing industries of this country and Canada and many additional thousands in various asbestos-consuming industries, increase! attention to this probable occupational narard of cancer of the lung by the medical profession is desirable. *Wyer's, later medical director of an asbestos producer, report on Hi deaths from ssbestosis in England also offered statistics dn the incidence of accompanying lung and pleural cancer.43 lint and pleural cancer were referred to aa one entity: 'The trttcrt.tr of pulmonary cancers in the eeriea was therefore 14.8 per cent.* Another case of asbestos is-lung cancer in an insulator was reported in 1951 49 The authors concluded that there was definite association between industrial axtosur* ea asbestos and lu.tr and urged that this relationship mandated tha undertaking of "careful: preventive measures*. -y**'of the Massechusetts Institute Of Technology referred '^.tb_:j^hr^^*.'report* of asheetosia with lung cancer m an saa who "worked for seven years sorting cardSt aaSifios JCUtT* ' intended for insulation and manufacturing | p: btfglWsd*?-' ,-:y/tf ' 'v* ?; Bartlcular significance since there ^***' 0*rI'I0190tt, workers expoeed to varyin amounts aShsCtftoa la American industry, many of tham in ; some operations not properly safeguarded against a potential carcinogen. 3(7 At 102 nn * O i. i Subsequently. Isaelbacher and Hardy and co-workers reported another caae of asbestosis with lung cancer in a cor.era era -e-pe who worked with aioetco* Inaulacion products In 195:.'' Weiss in Germany also in 1953 reported a case of pleural cancer with asbeatoais m a nan who had been an asset cos maulaticr. worxer. 52 Thus, jm-i-953 , five, different repbrtejgiVtHolleb arj~Tnasist 1942 - Ker^iafcdy 1947 - Stol b**x- 1951 -CIsselha^ti--r951 - Xii 1953) had appeared describing asbestoslAtlar.q cancer^.-, insulators and two leading researchers. Hueper and Hardy, had xprsssad specif' concern for users of asoeatos insulation products. In additon, Dr. Sreslov of the California Department cf ?up lit Health on early 1954 m an extensive epideciologit survey listed insulators as an occupational group excessively at risk to tsr.tcicti e3 lung cancer and called for further intensive investigation." In 1955, Coll in Sncland reported that of 105 asbestos _ textile workers examined at necropsy from 1935-1953, 19 hH l ine 54 -ancsr^ - Fcllcw-up study cr 113 ae.t with at least 10 years' expos, showed that 29 deaths had 1' only 15.4 would have beer, expected cased cr. general r.creality rates. The excess was entirely due ts lung renter 11 ___ ;t expected: er.d ether respiratory and cardccvasculer disease (12 acair.st 7.6 expected!. Doll r.ctsd that all cf the workers with 20 years or more exposure had been first exposed before the implementation of the asbestos ^industry,regulations.. Though ha had no data on the fate cf workers under the improved conditions, Doll believec jbeatos workers had become greatly reduced-; ' BritisfipbeetoirFteil PPteesen and co-workers in 1935, the t tr'.used the same asbestos that was Sntly.'-uietf-in the-Amec lean asbestos industry! ..... l-.'r -h asbestos fits*. Canada. chrysctile Tables 1 and 2 list additional post-1955 pret3 9 54 rase rsports and surveys of insulators with asbeitosis-lung cantsr. Sill-- --. -- -- ` 'J'C vs ^ S '/1 The isscstcs industry, avan. if it-maitfiar conducted incepandent rsssarch .-.or Ictpt ievirr^^iiTjrjadiel;'lit<ig^tttx*V'c4n not >:d . .. - jit ignorance of this proliferation of literature. demonstrating carcinogenicity of asbestos. As i* ravinl in rani** ? i:. many of these article*-war* either abstractjj5?\i^'v' 'I-*'- ,^3sf . ahortly after the article*'war* published.'ahd Urn* delivered - -5:..; o. the docr?t?r* of variou* of the defendant*, or/aere discussed - V> Axf'- flr at ATI meeting*. In addition, on thra*. diffareo&toeeaaion* in tha - ' C-..A mid 1950'*, tha ATI rejected proposals to fund ciSer ^studies one*) citing a fear that uch a study 'would aeir up a hornets nast and.,' place the whole industry undar suspicion." Or. Hueper's 1355 publication recaivad considerable attention at an ATI meeting in 1955, and aueper'a contention that asbestos users and- th* gsnsral. population wars at risk was emphasized. III. Mesothaj 1 nma .- ' - I^ f Most scientists bold the 'view that the seminal survey linking ^asbestos- with tbaa^dreadsfmesothalidmjr. tumor was published in I960. la that year, Wagnarj^ScutbcAfric* vreported 33 oases of pleural mesothelioma. *5 i "A, h*5ory 'of occupational or'environmental . exposure to-crocidolit*'asbestos .iit^tbe North West Cepe Province, ' 'i1*' ' -- '' 1 - - - where it we# mined/, was- .established for 32 of tha 33 cases. Most of these people hsd not been occupationally exposed to asbestos, but had lived near the mines and roads where asbestos was hauled and mine tailing* wera used m road construction. Several Insulators with asbestosis and mesothelioma were included in the group surveyed, lata la 1969/. X'al reported on 23 woman end 19 men treated - 11 ^ 56 as in-patients anSlURaatosis in on* hospital in London. Cf tbs IS men knotn?&tfSKfiDiiflKlajjrLth lung cancar and 1 waa kSKBf- with lung cancer -jrv* 1 rare*.! Tha 4 woman r.sU non-amok a r*. Tha JrV' 1 Rhsd can.cer of tha ,, u_?VadT<Sr and'ksJt^'th''19i0tegjftad tha opening of the floodgates ^o'<^^#otbgiioaJai^ej^'^elp^ttr?i.V*portegei.. In 19*2, tha British began to i7 peritonaua. * regiater o! .Tssothaliomaa of th* piaurs a-i In calling for information, Smithar and co-w7.-<s.-! ackr.cwladgad that: Thera appear* to be no correlation between the severity of any pulmonary asbestosis and the occuranca of these tuaors. In a number of'cases the exposure to asbestos dust appears to have been minimal, and the only .histological evidence of asbestos exposure is the presence or a few asbestos bodies and fibras in the lung- tissue.-^ However, a datailad occupational history has-, in nearly all cases, revaalad some contact with asbestos fibre. McCaughey in Belfast had first reported 15 cases of pleural mesothelioma in 1958, which he investigated further in 1962. lung section* revealed numerous asbestos bodies in only one of these cases, detailed occupational histories wers obtained fee 9 of the 12 cases in which asbestos bodiee were present in the lungs. In 4 of the 9 there wes *a clear cut history of intermittent exposure to aebeetoe*. In the other 5 there was no known asbestos occupation, but all had jobs in the shipyard which inevitably .brought them into intermittent contact with asbestos work -- for example, shipyard plumbing and furnace repeiring. In the United States, Or. Sisenstadt f-irst reported two cases of asbestosis-aasothalioaa `in a non-plant worxar exposed to asbestos insulation products In I960, 59 He followed this with a description of sa additional imilarly exposed worker with asbestosis - mesothelioma in 1962. This wes followed in 1963 by ths initial publication by :4or; Belikoff of .Ills epidemiologic survey of United States insulation ''.f vv, ' i&. workers '' Sxposurs and Neoplasia". 61 While thie "'""'fflPltfTBT poplea of the paper were' cireatete^^KfnRMMHSTunmfAR^meeting. While Vagner'i^Ud^study was. the first extensive review of the aeioUtiae:;hetMiiiiauiieMN,and mesetheliome, other scientists had been repert&gTea*eafor"`sabeatoa workers with pleural tumors 'm-V a sines 1143. In 1149 Wysrs, supra, reported in his series of esses :'P* ^ v ' j j' yr v. :*&* * ^ If?' in ascesto* worker*,** or * p*jnc. witiuerr^tfr*-. j. . . a or. the pltura-' (an eart?'.nomenclature for nec-.helior^ ';n J95:. '.t. i ^ ' ,y~ medical ifirestoafi'-of.; an-asbestos prot-ccer, repor-ec mesotte: .in, - *,-. p.-vt x. . .- , in two Canadian ssbestas S'- worker) . In i?5'. baicher in raining employees ;<r Germany Reported (cr.s: -f a cm -.-.sc vit a-. per; :srt.i. npe' '<'.'ith atbestcsia in ah'asbestos face::/ worker. 64 Th* -ore began asbestos work in 1919 and diad 11 vears later.- Asbestos /. T dust was positively identified in-'the tumor. Lei cher^,considered the cancer to be cf occupational origin, noting that such-Siaor* were very rare in the general population. Earlier reporta had listed 'metastatic tumors' in the pleura and peritoneum m cases ci asbestosis with lung cancer. "epert* of primary tumors-of there sites suggested that some of these earlier cases may have been misdiagnosed primary turners, not metastaaes. Bonser and co-workers, reporting in 1955 on post-mortem examination of 72 factory workers with asbestosis in the Vr.ited States, found 2 pleural and 4 peritoneal cancers. Eisenatadt, supra, cites several othar earlier suggestions c: an association between asbestos and mesothelioma, and Selikcff in 1965 cited a 1953 article by Weiss in which th* author described a case of asbestosis end mesothelioma in an insulator and surges tec c causal relationship.52 "> Aa warn, the ease with early reports of an association between `asbestos and lung cancer, industry did nothing to disseminate seen .information to insulators and expendad no funds to sponsor researr- denythe association prior to 1968. [' study in 1960, it becasw accepted itr ^ara occupational and even casual *po*g .sad to health hasarda. It is now that' persona; wi th as limited an exposure to *- - ix Insulator "husband's clothes may precipitate w .'if' -. ... . i-,,. ,-i- "< Indeedp the occupational Retards of handling asbestos are so -'wwwt -- --e ^pnth Of' ^ ... mV-yiwfcl . -->->; uao -tr . - "' vu s, meabthelioma. 11 asbestos plant has Li v. ' <v *V' Aa ii reflectad in tne iWMtmdi accorpar.y mg Sr. Kar..-,etf. Smith's 1949 health survey And in Or. Smith'* depositions, ;5ui. Kanville vaa * of health he**r7* *h* 7?pop-cl.- living naar asbestos producing facllitlaa aa early aa 1**9. tv. Threshold limit Valuaa - The defendants, as as adjunct to thalr *va didn't '/now' state of the art defense ara likely to also argue that they raliad on the ~V (aarliar called maximum allowable concentration or MAC! for aabaatoa and concluded that insulators vara r.ot at risk Bacauaa they supposed that Insulation work did not entail exposure to levels above the TIT. Of course, no one tested the level of emission at Insulation job sites prior to 1970 to determine whether the 717 was being exceeded and no defendant sponsored research, such as that undertakan by Sellkoff, which has dMenstrsted conclusively - that asbeatoa diseases can be produced at levels significant^:- lower thaa the poat-X93* T1V. 1. Definition. i The Threshold Lisiit Value is promulgated by the America.-. Confermccj 'of',Govcnmntal-industrial Hygienists aa unofficial body with .-.a . legislative. powers, Aa defined by the ACSXSt 'threshold liners should be; osed ae guides in the control of health hazards and should "'3R. - :i .. :i-' " not be regarded.as fine llnee beewean safe and dangerous concentrations Thar TS.V. for asbestos'from 1931 to 1969. was 9 million particles par % cuhlo foot. ThsT TLV required e count of dust particles rather than --Yci__c.t,.-. -.5 c1 A- :r ' ------ - \ikhmant of. a TZ.V for aabaatoa. 11th Sarvlca was raquaatad by the health rth Carolina to make an eng inear mg .iSJAVv"*' r*'?* Ltions in that state' aabaatoa textile fustry. Tito results were published in detail aa a Public Health lullatin la August.`1931' and la more concise form in the American Journal of Public Health la 1939.**' ** In all. 342 dust counts were made to seeaure workers' et^osure. The counts employed standard methods for that time, and all pertlelee S -82 the air -ere rcur.ted, not ;-i: asbestos fiber*. Tr.e ur.it cf measurement of airborne duet concentration wee i million pertici per cubic foot r * --* aaxlmu *-*--f v- '<.3 Medical examination* ware made of 341 men end wotaen repreaenting practically ell- of. the aaploveee et the time of the itudy..V-iTh#,. tree fectoriea atudied bed been in operational o It years. About IS months before the studyapproximately ISO workers were replaced by new ones with little or no asbestos axperiaaee. As a consequence, there wee an abnormally large percentage of worker* with lea* than S years' employment in the eebeetoe textile industry and an abnormally aaall percentage who had worked 10 year* or more in the induetry. The Public Health Service reported. The percentage of person# with aabestosi* increase* greatly with increasing lsngth of employment.... [A] lmost three-fourth* of the workers employed for more than IS years have the early stages, at least, of a disabling disease, asbestosis. Since there is no satisfactory way of locating and examining persona who drop out of an industry because of disebillty incurred therein, the percentage values of the foregoing tables are necessarily minimal evidence of the prevalence of asbestos!*. -- ISr3 per cant of the 69 former asbestos workers {who had been traced) and 37* man and women employed at the time of eh* study in thrse asbestos textile factories had asbestosis. (Persona who were not exposed to'appreciable quantities of asbestos dust have not been Included.) (The non-exposed persona may have been office workers and ether nbii-production personnel). in the factorise by the tin* they w#r*inspected by the Pui-.t ; ''' -' . " Health 93 more asbestotics .-.ad ce*. fired-by the sill-'"own ersnshertly before-. the-public Health >rv.:e conducted i t,- survey. 3v f.iing employee* with long-term exposure, especial..;. ,.i the least dusty process**, the corapenilss^wiped.iDutjnost of t-.e V : W~' ' data base the Public Health Service needed' rat'order; to develop any good dose-response data on asbestosis. Only S workers or. the study who were considered at risk of disease had been exposed. to levels under 5 nppcf for ever IS years. None of the 39 persons exposed to dust concentrations below 2.5 c.illicr. particles per cubic foot had a caae of asbestosis, although, as * natter of fact, only 5 persons had been employed acre than 5 years. There were 3 'doubtful* or borderline cases of asbestosis found among the workers exposed to 2.5 to 4.9 nppcf. Despite toe paucity of. data on the risk among workers exposed to less man Suppcf, a tentative thresholdvalue for asbestoe dust exposure ;'~L ~ ' of 5 appef- wee- designated. This value stood as the recognized TLV~in the United State* for the next 30 years. The. Public Health Service investigators were assigned the difficult task of prescribing a limit that wontd be safe ari demonstrably attainable with available process controls. They cited e 1935 Pennsylvaaia study that .showed that incidence :i asbeetesia. iacreesea with the: concentration of airborne dust and -vafv--:' v y-4dr h>that found'no'safe threshold: . ofi* * laHer study carried on in textile factories. Pulton, found that S per cant duet ir >f t`a f . && flndinge and the 5 appef .. *--ie^hstudy was not resolved least}' the Public Veeith f ervice r ,4 V'based solely on Its own health and engineering study ignoring the Pennsylvania study end British studies* ' -WV r >. -~r- i&r- S#cau*e'-bf th* importance of. th# `jfirafel**, le seaas to.be daaifabi*. to. useauch data.as ara" atr baiid tat define t*ntativ*-*e/*wbcking condition*-, that say serve u ituiUriU fat tha guidance. of factory, nanagar*" and eaginaari until sera coapiati daJ'-r'ar* available.:.-. Sacauaa clear-cut caaaa of- asbaatosi* war* found only in duat-concantratioaa axeaedlng f Million particle* par cubic foot,'and because they vara not found at-lower duat concentrations', 5 sillier, particles par. cubic foot say,bc. ragaxdad tentatively aa the threshold value for asbestos duat exposure until battar. data ara avalldl*^v^-jhfc> .. _i. Is ordar to find out th* l7*la v'wt(idi asbestos .-V--. i duat concantration* hav* baan raducad^la prattles, aa anginaaring study waa sad* in an asbe*to*"textil#;r-`** factory in which duat oonerol aguipoant has baan racantly installed. Thia shows that naans axa already availabla for reducing tha duat exposure of a majority of aabaatoa taxtil* workers to lass than 5 aillion particlaa par`cubic foot. Th# investigator* ware optimistic that no new eases of asbestos!* ' .would appear if aabaatoa'dust concantration* in workplace air wars kept below # appef--and- followed by describing S sppef as a -'tentative tKraahoid* ` that could b* achieved with availabla '>*-i v l, bathed*. oft duet* control. -- - >%-T ' [`C -ft'-* ""S' . : i' . - r >'v-1' r XWfdfnMtalxVr nothing vm'publishad'aftar 19 3S that led to tha datarn1nationr?qf jk-hbraabold Cox worker, exposure that would ~ -. >>- - -<: 1" ' protect: ag ' aia for th* ' next-. "" 3(V yj:_y_ri. Worldwide VisageTM;-' - aalaa.of aabaatoa^fibaa-fres 1*:: ,ir<3 me fron 02,000 tons par T' .. iy.1t :;*& ;v '' I' ' :-yearpar yaar, with tbatJ. S. in 19 6 > cons using *..Vl": -- ' 7n 7i-. ... abeuti SS^sar canvof ;world output.' ' y "SkT' mi ,V. , . .... ' ^^^,~''SSlu#tryfdisaartiafaction with. tha tl,*.' *V ^ASX/ara-r*pl#ta.iritb., avid*nc* of diasatiafactiaa appef^iuggaatad by Oraaaan in .. ' .,5%, :H .i -. yraneO'.ia iMaia the? fact that- tbs ' itroi.ksd tills is attrlbutad March 10.'195<, W La criticised for raguirlng. a duat rather than fiber count; (e) The June 9, 1954, ninutaa reflect that th* Stats of Maw Jarsay had specifically redactad the flV bacausa of its insiatanc# on counting duat rather than- fiber*. r' ',-\S - .* - H.. -wtr Or. 0. A. Sander, nadic*l'eonsultju>t to/anjasbeattisi producer, -ysv-.' wrote in195.1 that companies should emphasise duat^suggj^i*dwsr ether \r' " "r > -. 7J O- J' ' than achievement of. levels consistent- wlth~ thft^ST* ~ _ * 7V Or. Smith testified in hia deposition that Johna-Hanvilia ' 7*^-- ` in tha aarly 1950 ' aeeamptad to achiava duat levels-^ irf? the Ccr: ^ varioua oparationa below tha TLV and aae operating standardsbelow auch a laval. :\ . In sum, tha TLV waa navar intended to ba a 'fine liae*^>arlwi. which diaaaae navar appaarad and was not considered to ba such by industry.