Document 1Qv43zQBKb2n1z5ZaeqaBv7Jm

1 PLAINTIFF'S EXHIBIT AL-1240 1968 Yant Award Is- i \ Occupational and "Non-occupational" Asbestosis in Finland By LEO NORO, MJD. Institute of Occupational Health Helsinki, Finland i i >! Preprinted from AMERICAN INDUSTRIAL HYGIENE ASSOCIATION JOURNAL , Volume 29, May-Jurie, 1968 409677 0498 American Industrial Hygiene Association Journal 197 as 2500 B.C. or 4,500 years ago people in Finland knew how to add fine asbestos fiber to raw material for pottery. The technical significance of this discovery is obvious. In the same way that asbestos is now used to improve tensile strength (in the armoring of cement products, for example) so it was once used to strengthen the sides of lightly fired pottery. When the material had been strengthened, the sides of the vessels could be made thinner. In this way cooking utensils were produced which were not only lighter in weight but in which food could also be cooked more quickly. This surprisingly mature tech nical invention found also a practical adapta tion which commands respect for the eco nomic instincts of those forefathers whom we often regard as very primitive people. Asbes tos pottery was not limited to being a pro vincial specialty of eastern Finland; it spread over a wide area of Finland, Scandinavia, and Russia. The asbestos pottery as found in Finland and in neighboring countries is unique--nowhere else have discoveries of that kind been made! This use of asbestos also illustrates that ex posure of man to occupational asbestos in handicrafts has at least a 4,500-year-old his tory in Finland as well as the non-occupational exposures in asbestos areas. But only since 1918 have we had a modern industrial exposure of workers in quarry, mill, and fac tories. Our eastern neighbor, Russia, started the production of asbestos as early as 1712 during the reign of Peter the Great. Their production at present is already approxi mately two million tons per year, half the total of world production per year and twice as much as the United States annually uses. Finnish Asbestos The present production in Finland is only 11,000 metric tons per year of anthophyllite asbestos. The asbestos dust in the quarry and mill mineralogically contains: Anthophyllite Talc Chlorite 30-75% 20-60% 3-13% The theoretical chemical composition is (Mg, Fe'*') 7 [(OH)i (Si,On),]. There are small amounts, perhaps smaller than in Canadian asbestos, of some metals such as Ni, Cr, Co, which might have some cancerogenic interest. Levels of Exposure to Asbestos Dust Unfortunately the exposure levels at plants have been systematically measured only dur ing recent years. Twenty years, ago, before the management of the quarry and mill changed, the dustiness was, especially in the mill, rather great. One could only see a few meters ahead. The level of dust was surely many times higher than what our threshold limits indicate it should be. This great expo sure reflects in the frequency and severity of our asbestosis cases, which will be presented later. The present situation of dustiness will be reflected in the morbidity of the next ten to twenty years. In the entire asbestos industry approximately 225 different jobs have been examined. In three-fourths of them the level of dust is under the threshold limits, but it is higher in the remaining one-fourth. We have used: (a) gravimetric samples taken with electrostatic precipitators (MSA) and/or with membrane filter field monitors (Millipore Filter Corp., Type AA), and (b) breathing zone samples taken with an impinger (MSA) for particle counting and siz ing under the microscope. X-ray diffraction methods are used also. In the mill and quarry the total quantity of dust varies from 7.5 to 100 mg/m3. In other working places the level of dust varies from 0. 3 to 10.6 mg/m3 or 11 to 2,400 particles/ cm3. Only 1% to 5.4% of the total dust (impinger-method) has been fibrous particles, 1. e., 5 p in length, the length being three to four times the width. In this connection I would like to mention that in eastern Europe (the Soviet Union, East Germany) the thres hold limits are somewhat lower than the western ones: 2 mg/m3 or 100 to 150 par ticles/cm3. The level of industrial hygiene in Finland is not yet satisfactory, and unfortunately we must expect still more asbestosis cases. Medical Findings The first medical survey in our asbestos industry was made in 1946 by C. Wegelius. American Industrial Hygiene Association Journal 199 tion over fifteen years of age. Under the age of 40 years they were rare, but in persons over 65 years of age the calcifications were observed in almost 30%. In the rural popu lation elsewhere in Finland only seven cases were found in the 265,223 people examined, but in two larger towns they were more fre quent, 0.7% of the examined. Kiviluoto has later found 77 cases of calcifications in 35,000 chest x-ray pictures from the population of our second largest city Tampere. Bilateral thickening of the parietal pleura is, however, a very common finding at autop sies in all of Finland, as Dr. Meurman stated in his study in 1965. He found them in 39.3% of his cases, equally in eastern and western Finland. In 70% of the cases the plaques were bilateral and in 72% the find ings were in men. They were more common in the urban population (52.2%) than in the rural areas (31.8%). In the asbestos area the incidence and calcification of plaques were higher. Asbestos bodies were present in 57.6% of the 264 lungs studied, in tnen 60.1% and women 54.3%. Other findings were: --The frequency of asbestos bodies in the lungs is higher in urban than rural popu lations (70%-49%). --The frequency of asbestos bodies in the lungs of persons in the asbestos area was greater (however in 5 cases of 15 no asbestos bodies could be found). --In farmers asbestos bodies were found in 47% and in building workers and work ers of corresponding trades in 67%. --Asbestos bodies could not be detected in plaques. --There was a positive correlation between the occurrence of asbestos bodies in the lungs and of pleural plaques. In cases of bilateral plaques 85.7% exhibited asbes tos bodies in the lungs, but, on the other hand, approximately 40% of the cases showing asbestos bodies in the lungs were free from pleural plaques. --The plaques did not have any correlation with emphysema, heart disease, pulmon ary stasis, or pulmonary tuberculosis. Chronic bronchitis was not studied. Perhaps the most important finding is that pleural plaques are a very common disease in the entire population. Already in 1884Cursch- mann described them as "sugar icing"-- "Zuckerguss"--at the time when the asbestos industry was only starting in some countries. Asbestos bodies--if they are all asbestos (?) -- are rather frequent in lungs: in Finn;sh mate rial in 57.6%, in some oth"r material between 5 and 50%. (It depends on what kind of method is used and in what detail the lungs are studied.) This does not mean, however, that they are "asbestos's cases," as Chemical Week (Sept. 10. 1966) seemed to think wh-n it stated. "Forty per cent of all Americans have mild, chronic cases of asbestos's." We do not even know yet what materials are a part of the needles, fibers, bodies, etc. which have been found in the human body. In the Finnish asbestos area, however, cal cifications, visible in x-ray pictures, are much more common than in other parts of the country. Air pollution is not the only cause of exposure. We have made some investiga tions and noticed that calcifications are found outside of- the area where asbestos dust spreads. Of course, the local exposure to dust (asbestos ovens, asbestos stones in the sauna, agricultural exposure from dust in fields, etc.) could be a cause. But also the entire geomicrological composition of the soil is differ ent. In our preliminary studies in this area we have noticed great differences, for ex ample, in the Mg-content of the drinking water, which might influence the calcification processes. The study, however, is not yet finished. It, nevertheless, seems that asbestos in the air or soil has something to do with calcification of plaques, because also in occu pational asbestosis cases pleural calcifications are rather frequent symptoms (in our mate rial of advanced cases in 100% of them). What then is the prognosis of plaques and calcifications? Does one part of them develop into mesotheliomas and why? This is an in teresting question. Our Finnish experience does not as yet prove it to be so. You might ask, "If you find this kind of peculiar pleural changes in even 9% of the population, then what is the situation in re gard to pleural malignancies and mesothelio mas in this area which already has a 4,500year history of endemic exposure." The Fin- American Industrial Hygiene Association Journal 201 Finnish Bibliography on Asbestosis Ahlman, Kaj: Asbestosis among Insulator Woikers in Fin land. Proc. XV Imt. Congr. Occup. Health, Vienna 11966). Aurola, E., and A. Vesasalo: Ober die A&bestvcrkommen Finnlands und ihre technische Verwcrtung. Geologische (J ntersuchungsansialt, Geotce hnische Veroffentliehungen Nr 54 (1954). Finnish Mineral (Carisson): The World's First Asbestos Mer chants. Kiviluoto, R.: Pleural Calcification as a Roentgenologic Sign nf Nonoccupational Endemic Anthopliyllite-Asbestmi*. Acta Radiol. (Stockholm) Suppl. 1960:194 (I960). Kiviluoto, R.: Pleural Plaques and Asbestos; Further ob servations on endemic and other non occupational as bestosis. Annals N. Y. Acad. Sci. 132: 235 (1965). Kiviluoto, R.: Pleural Calcifications and Asbestosis. Brit. ]. Radiology (1967). Laamanen, A., and V. Raunio: Observations on Atmospheric Air Pollution Caused by Asbestos. Annual Report of thr Institute of Occupational Health 1964, Helsinki (1964). Laamanen, A., Leo Noro. and V'. Raunio: Observations <-it Atmospheric Air Pollution Caused by Abestos. Au. Acad. Sci. 132: 240 (1965). Mcurrnan, L.: Asbestos Bodies and Pleural Plaques in a Finnish Series of Autopsy Cases. Acta Path. ScanH. Suppl. 182 (1966). Noro, Leo: On the Histology of Asbest<*sis. Ada Path. Mi crobiol. Scand. 23: 53 (1946). Noro, Leo, K. Ahlman, A. Laamanen, and M. Viikcri: Asbestose als Berufskrankhcit in Finuiand. Int. Arch. Gewerbcpath. 22: 179 (1966). Noro, Leo, K. Ahlman, A. O. Heinonen, T. Partanen, E. Rintala, E. Siltanen( and M. Viikeri: Occupational Anthophyllite-Asbestosis in Finland (A preliminary re port) : Second International Conference on the Bio logical Effects of Asbestos. Dresden 1968. Raunio, V.: Occurrence of Unusual Pleural Calcification in Finland in Studies or Atmospheric Pollution Caused by Asbestos. Helsinki (1966). Siltanen, E.: Industrial Hygiene Aspects on Studies of Asbestos Dust at Working Places. 1VA. Stockholm (1967). Siltanen, E.: Observations on the Asbestos Dust Measure ments. Czechoslovak-Swedish-Finnish Symposium on Pneumoconioses. Prague, June 12-17, 1967. Wegelius, C.: Changes in the Lungs in 126 Cases of As bestosis Observed in Finland. Acta Radiol. (Stockholm) 28: 139 (1947). Viikeri, M., and K. Ahlman: Radiological Classification of Cases with Pneumoconiosis in the Light of a Croup Study. SLL 19: 2211 (Finnish) (1964). Viikeri, M., t at.: UltrashaU Examinations in Asbestosis. To be published. * 409677 0505 409677 0506