Document 1ymE0M235bLKma6O1LJGVEGVK

OCT 30 1978 .rv/I DRAFr SUMMARY ESTIMATES OF THE FRACTION OF CANCER INCIDE~CE IN THE UNITED STATES ATTRIBUTABLE TO OCCUPATIONAL FACTORS NATIONAL CANCER INSTITUTE AND NATIONAL INSTITUTE OF. ENVIRONMENTAL HEALTH SCIENCES Not for use before 3:30p.m. EDT September 11, 1978. FMSI 05056 '"2.#1\ J ( tc, ) This statement will address the ques.tion: "What fraction of the cancer incidence in the United States is attributable in whole or part to occupational exposu=e to carcinogens in the workplace?.. The conventional est~tes have been that this fraction is quite small. and figures of between one percent and five percent are often quoted. However as. we will show below, these estimates were admittedly speculative and were incomplete or deficient in several respects. If the full consequences of occupational exposures in the present and the recent past are taken into account, est~ates of at least 20 percent appear much more reasonable and may even be conservative~ Basis of the Estimation that 20 Percent of Cancer Deaths will be Associated with Occuuational Exnosure to Che~icals I. Asbestos as a Well-Studied ExamPle The consequences of occupational exposure to asbestos in the United States have only been fully recognized in the past year. According to estimates made by the U.S. Department of Health, Education, and Welfare, between eight and eleven million workers have been exposed to asbestos in the U.S. since the beginning of World War II. Of that total, approx~tely 1.5 to 2.5 million are presently employed, while the remainder -- between 6.5 and 8.5 million workers -- were formerly employed in environments with significant asbestos exposure; including 4.5 million who worked in shipyards during World War II. Of these workers, approximately four miliion are believed to have had heavy exposure to asbestos. Based on epidemiological studies of workers, it is estimated that 20-25 percent of heavily exposed workers die of lung cancer, 7-10 percent of pleural or peritoneal mesothelioma, and 8-9 percent of gastrointestinal cancers. These figures are probably underestimates of lifetime risks. because relatively few workers have yet been followed to the end of their normal lifespan. The total fraction of heavily exposed workers likely to d~e of these cancers is probably between 35-44 percent. FMSI 05057 - 2- Of the four million heavily expose"d workers, approximately 1. 6 million are thus expected to die of asbestosrelated cancers. Assuming that the excess risk to the 4-7 million less heavily exposed workers is one-quarter of that to the heavily exposed workers, the total number of cancers associated with asbestos in the less-heavily exposed group would be expected to be about 0.55 million, raising the total to about 2.15 million. Since most of these cancers will be manifested in the next 30-35 years, the expected average number of cancers attributable to asbestos per year in that period will average about 67,000. Such numbers would represent about 17 percent of all cancers detected annually in the United States. II. Other Less Well Studied Examples Arsenic Number of workers potentially exposed: about 1,500,000. Risk ratios*: 3-8 for lung cancer> Estimated number of excess cancers per year: 2,100- 7,300. Benzene Number of workers potentially exposed: about 2., 000,000. Risk ratios: 2-3 to 7 for leukemia. Estimated number of excess cancers per year: 240 - 1,400. Coal Tar Pitch Volatiles and Coke Oven Emissions Number of workers potentially exposed: about 60,000. Risk ratios: 2-6 for cancer of the lung, larynx, skin. and scrotum. Est~ated number of excess cancers per year: 16Q-800. L * Risk Ratio: The ratio of cancers to the number expected ~ a normal population. A risk ratio of two means a doubling of the risk. ----------------- FMSI 05058 ...,_ 3- .- ~ 7L~.~~~ v-~umber of workers potentially exposed: about 2,260,000. Risk ratios; 200,4 and 1..9 respectively for hemangiosarcoma, brain and lung cancer. Estimated number of excess cancers: 1,940. A total of ta/-S p~rcent of the cancers occurring in a year will be associated with these four substances .. III. Substances for which excess cancer incidence has been recorded but for which es.timates of the number of workers exposed may be less accurate. Chromium Number of workers potentially exposed: about 1,500,000. Risk ratios: 3-40 for nasal cavity and sinus, lung and larynx. Estimated number of excess cancers per year: 2,40046,000. Iron Oxide Number of workers potentially exposed: about. 1,600,000. Risk ratios: 2-5 for lung and larynx. Estimated number of excess cancers per year: 1,300- 5,000. Nickel Number of workers potentially exposed: about 1,370,000. Risk ratio: 5-10 for lung. Estimated number of excess cancers per year: 3,800- S.tOOO. Petroleum Distillates Number of workers potentially exposed about 3,000,000. Risk ratios: 2-6 for lung and larynx. Estimated number of excess cancers per year: 2,400- 12,000. A total of 3-18 percent of the cancers occurring in a year ~11 be associated with these four substances. i 'l FMSt 05059 --------------------------------------------------------- 4- IV. Totals. Thus the total excess incidence would be ram 21 to 38 percent. We choose to use the figure 20 percent in order to be conservative. Summary and Conclusions 1. The oft-quoted estimatess that only 1 percent to 5 percent of total cancers in the United States are attributable to occupational factors have not been scientifically documented. 2. Most cancers have multiple causes: it is an error to attempt to assign each cancer to an exclusive single cause. 3. Because cancer incidence is strongly dependent.on age and upon duration of exposure, most cancers resulting from exposure to carcinogens ~11 occur late in life: many epidemiological studies detect only a small fraction of early-developing cancers. . 4. Past exposure to asbestos is expected to result in over 2 million premature cancer deaths in the next three decades: this corresponds to roughly 17 percent of the total cancer incidence expected in that period.. 5. Reasonable proj ections of the future consequences of past exposure to established carcinogens suggests that at least 8 other substances may contribute substantially to cancer incidence comparable in their total effect to asbestos. 6. The projections suggest that occupationally-related cancers may comprise 20 percent or more of total cancer incidence in -forth-coming decades. (This does not include cancers attributable to ionizing radiation.) 7. Although exposure to some of the more important occupational carcinogens has been reduced in recent years, there are still many unregulated carcinogens in the U.S. workplaces; a number of occupations are characterized by excess cancer risks which cannot yet be attributed to specific agents. 8. There is no sound reason to assume that the future consequences of present-day exposure to carcinogens in the workplace will be less than those of exposure ~ the recent past. 1 FMSI 05060 ---------------------------- ..~ ~ - 59. Patterns and trends in total cancer incidence (and mortality) in the U.S. are consistent w~th the hypothesis that occupationally-related cancers comprise a substantial and increasing fraction of total cancer incidence. FMSI 05061 FRICTION MATERIALS STANDARDS INSTITUTE, INC. , ,:r 1; OSHA's current promulgated on June 7, 1972. It as-" bestos" as chrysotile, amosite, crocidolite, trem.:. olite, anthophyllite, and actinolite and included every product containing any of these minerals. For regulatory purposes, an asbestos fiber was defined as a particulate form of asbestos, longer than 5 microns, with a length-to-diameter ratio ~of at least 3-to-1 and a maximum diameter of a5 microns. " . _ . . _ The 1972 ~standard originally established of s'. ' maximum 8-hour tilrie-weighted-average (TWA) c. :;-;"' -. concentration 'asbestos fibers per cubic acentimeter of .air. and 'ceiling.exposure limit of 10 fibers per cubic' centimeter. On July 1, 1976, a further provision of the standard took effect, lowering the permissible 8-hour TWA to two fibers per cubic centimeter of air. The two- fiber limit remains in effect today. On October 9, 1975, OSHA proposed a new regulation for asbestos. Among other things, the proposal would lower the permissible 8-bour TWA exposure level to 0.5 fibers per cubic centimeter and would reduce the permissible ceiling exposure level to 5 fibers per cubic centi- meter for any 15-minute period. This proposal would not apply to the construction industry, which would be required to follow a different standard to be proposed later. A separate asbestos standard for the construc- tion industry has not yet been proposed, nor have bearings on the 1975 proposal been sched- . uled. An economic impact statement concerning - the proposed revision is nearing completion. Meanwhile, on December 2, 1975, OSHA asked 'NIOSH to reevaluate available informa- tion on the health effects of occupational ex- posure to asbestos. Completed in December of 1976, the NIOSH reexamination was forwarded to OSHA in May. Finding no evidence of a "safe" level of asbestos exposure, NIOSH recommended treating asbestos like other carcinogens by allowing only the lowest exposure level detectable by available analytical tech- niques. NIOSH recommended a 0.1 fiber TWA and a 0.5 fiber ceiling limit for occupational ex]pmiur4~S to asbestos. --.JOB. SAFETY AND HEALTH September 1977 FMSI 05062 < Polycyclic Aromatic Hydrocarbons in Soils of a Mountain Valley: Cor1elation with Highway Traffic and Cancer Incidence Max Blumer1 Woods Hole Oceanographic Institution, Woods Hole, Mass. 02543 Walter Blumer Arzt fUr Allgemeine Medizin FMH. CH-8754 Netstal, Switzerland NOV 15 1977 Theodore Reich Statistical Department, Institute for Radiation Therapy and Nuclear Medicine, University of Zurich, CH-8006 Zurich, Switzerland Analyses of soils in the vicinity of a Swiss mountain town show a correlation between the content of polycyclic aromatic hydrocarbons (PAH) and the proximity to a highway. PAH contents range from 300 mg/kg dry soil near the highway to 4-8 mg/kg in the surrounding higher alps. The P AH composition ranges from three- to eight-membered rings and to heavily alkyl-substituted derivatives. The PAH mixtures are far more complex than was assumed in the pa8t and resemble that of automobile exhaust. The low values in town close to . industry but remote from the highway, and high PAH values outside of town but near the highway suggest a correlation between automobile traffic and P AH content of soils. These results indirectly suggest also a correlation between the au~ tomobile traffic and the observed mortality from cancer in this area. An epidemological study of a Swiss mountain town has demonstrated a strong correlation between cancer incidence among the residents and the proximity of their residences to the highway (1 ). The town of 3000 inhabitants is located within the 1-km-wide base of a deep valley with predominant winds along its axis and with frequent thermal inversions. It is divided by a 40-m-tall alluvial cone into the older main section with residential housing immediately adjacent to the heavily traveled highway (4000-5000 vehicles per day) and a newer section, about 400 m from the highway and shaded from it by the alluvial cone. Until recently, this section of town was serviced only by a dead-end road. During the period of the original study (1958-1970), death from cancer was nine times as frequent for residents near the Ihighway. A total of 72 persons died in the old part of town of various forms of cancer, whereas only three cases occurred in the traffic-free area. Cancer mortality near the highway is higher for all groups of residents, without correlation with age, sex, occupation, and smoking habits. Thus, 32 women died; none of them had smoked. This suggested a link between cancer incidence and environmental carcinogens, associated with the highway traffic, among them petroleum- and coal tar-based road asphalt, tire particfes, lubricants, asbestos, and the components of automobile exhaust (lead compounds, polycyclic hydrocarbons, and other reactive chemicals). We have now surveyed the soils of this valley and of the surrounding mountains for their content of polycyclic aromatic hydrocarbons (PAH), as a possible group of trafficlinked carcinogens. Samples were taken immediately below the grass within the uppermost humus layer; those representative of the soils near the highways were collected within 1 m from the edge of the road. A dust sample was gathered from a high windowsill in 1 Deceased. 1082 Environmental Science & Technology. the town church, 50 m from the main highway, and a soot sample was taken from the exhaust pipe of a small car and from the chimney of a residence heated with fuel oil. Most samples were handcarried to the analytical laboratory; they were kept under refrigeration in clean glass containers until . extraction. Isolation of the PAH fraction.and its final analysis followed the procedure of Giger and Blumer (2), except for the more efficient distillation into the mass spectrometer source from a glass capillary with restricted opening (3). During each distillation 40 spectra were obtained at 12 eV and inspected on a Finnigan 3200 mass spectrometer with a 6000 data system; the total spectrum for each sample was reconstructed by the summation of all spectra containing appreciable intensities (3, 4) of the PAH molecular ions. Table I presents the total weights of the purified P AH fractions. These values are reproducible (2), but they may include the weights of some non-PAH impurities that were not rejected during the separation. Lower values are obtained by UV analysis, since they neglect the presence of alkylated PAH series and of still unidentified PAH components that are evident from the mass spectra. In our interpretation we consider the 12-eV mass spectra. the UV spectra, chromatographic mobilities, and the relative volatilities as observed in the probe distillation._We believe that our structural assignments (Table II) are sound, since they rest on the correlation of these different and independent analytical parameters. The mass spectra of the P AH fraction demonstrate a nearly uniform composition in all of the soil samples. Unsubstituted hydrocarbons predominate and range from phenanthrene to seven- and eight-membered aromatic ring systems that have not been identified before in environ- mental samples. Each unsubstituted hydrocarbon is accompanied by alkyl-homologs in gradually decreasing concentrations to C5 and beyond, with nearly identical abundance patterns in every series. Many isomers, differing in ring arrangement and in position and structure ofthe"side chains, may be present. Some well-known carcinogens (benzo[a]pyrene, benzanthracene) occur together with other carcinogens and cancer initiators, whose presence in environmental samples is rarely considered (methylchrysenes). In addition, vast numbers of aromatic hydrocarbons are present whose structures are not sufficiently well known to assess their biological effect. Among these there may be many still unknown carcinogens and mutagens. The composition of natural PAH assemblages is influenced by the processes involved in their formation (4-6}, and chemical analysis can therefore distinguish between contributions from different sources. For instance, the relative abundance of alkylated P AH derivatives is influenced by the formation temperatures of pyrolytic PAH mixtures. At high temperatures, such as in the coking of coal, only the unsubstituted hydrocarbons are formed or survive, while at lower temperatures, for instance during petroleum formation, highly . alkylated p:oducts predominate. These compositional fea- FMSI 05063 ~-13 . (~) ,tur~urvive the processing to road asphalt and pitch (7). The mass spectra of the soil hydrocarbons demonstrate an alkvl- ation patte.<n different from those of co&I t.s\r .,r petroleum (4, 5). The predominance of the unsubstitut.ed hydrocarbons and the gradual decrease in concentration toward the more al- kylated members speak for a pyrolytic origin at intermediate temperatures and enable us to rule out a major contribution from petroleum- or coal tar-basedroad asphalt or from lu- bricants. In spite of the general compositional uniformitv we note some subtle differences between samples. The soo.t.from the exhaust pipe of a car contains the same extended PAH series as the soils (a finding in disagreement with earlier analyses obtained with less highly resolving methods). The PAH mixture is depleted in the lowest boiling hydrocarbon series. Apparently, this series is not retained within the hot soot deposits in the exhaust system of the engine. Rather, these compounds pass into the atmosphere, which is consistent with the observation that the phenanthrene and pyrene series are considerably more abundant in the dust from the church, even ifthat sample has a similar overall composition in terms of ring systems and alkyl-derivatives. Correspondingly, the content of low boiling hydrocarbons in the soils near the highway is intermediate between the soot from the exhaust system of the car and the material collected in the church. The soot from the chimney of a residence heated with fuel oil has a very different PAH composition. There, alkylated members of lower molecular weight PAH series predominate, and the unsubstituted hydrocarbons are in the minority. Higher ring-number series are present at low concentration or altogether absent. Thus, this soot sample reflects the Table I. Total Polycyclic Aromatic Hydrocarbons in Soils and Sediments Within town PAH, mg/kll drywt Center of town (470 m elev.), at highway North end of town, at highway South end of town, at highway South end of neighboring town, at highway Dust from church, center of town. 50 m from highway Outlying section of town, light traffic, 400 m from main highway Outlying section of town, dead-end road, 250 m from main highway, 100m from foundry Secondary road in village, at road 110 220 85 300 100 21 6 18 Open country At main highway, 750 m south of town 300 m from main highway in valley 700 m from main highway in valley 1000 m from main highway, alluvial plain 120 15 5 5 Alpine soils, side valleys Camp ground, 850 m elev., no through traffic Mountain pass, no road. 1200 m elev. Alpine meadow, 1600 m elev. 8 6 4 Soils, marshes, and sediments, USA Maine, forest. 115 m from secondary road Cape Cod, forest, 750 m from highway, 400 m from secondary road Air base, Cape Cod, sandy soil, 2 m from highway Marsh. Cape Cod, 750 m from highway Buzzards Bay. Mass., marine sediments, surface 7 13 2 19 4-5 compositional features that are characteristic for crude oil and its distillates, rather than for high-temperature pyrolysis products, as is the case for car exhaust. The aromatic hydrocarbon composition nf these Swiss soils is very similar to that of recent marine sediments and soils from the U.S. northeast coast. We believe that two different processes, but operating at similar temperatures, have produced a similar set of hydrocarbons. Those in the U.S. samples, and possibly also in the high Swiss Alps, originate in natural fires; they are transported through the troposphere on soot particles and enter the sediments with fallout {4, 8). Extended air transport would result in depletion of the low boiling hydrocarbons. This is observed both in the U.S. samples and those from the high alps. These hydrocarbon assemblages at concentrations near 5 ppm may well represent a worldwide PAH background. The high PAH levels at the bottom of the Swiss valley, on the other hand, cannot be attributed to the same source, especially since their concentration far exceeds the levels in the immediately surrounding alps. The association of such high PAH levels with the proximity to the highway (Table I) suggests that they are produced in internal combustion engines. A major contribution from other PAH sources linked to the town or the highway can be excluded. Industrial and domestic heating produces some PAH. However, the low levels in town close to industry but remote from the highway, and the high level atthe highway outside the town, speak for the association of the PAH production with the traffic. Aromatic hydrocarbons are also associated with the carbon used as filler in automobile tires. A comparison between tire life and gasoline consumption of automobiles suggests that even a minor conversion of the fuel into carbon can produce soot much more rapidly than it would be released by tire wear. In combination, the geographic distribution of the hydrocarbons, the correlation between structure and processes of formation, and the chemical agreement in the PAH composition of soot in automobile exhaust with the soil hydrocarbons provide a powerful argument that car exhaust is responsible for the observed PAH accumulation in the Swiss Valley. This work has many consequences. Our new analytical data, -. Table II. Aromatic Hydrocarbon Ser!es in Soils Initial mass Extent of series Representative compounds 8 178 ToC6 Phenanthrene (UV) 202 ToC6 Pyrene (UV), fluoranthene (UV) 228 ToC6 Benzanthracene {UV), chrysene {UV), triphenylene 252 ToCs Benzo[a]pyrene (UV), benzo[e]pyrene (UV), perylene (UV) 276 To~ Anthanthrene (UV). benzo[ghi)perylene (W) 278 ToC9 Picene, dibenzanthracene, dibenzophenanthrene 300 ToC7 Coronene (UV) 302 ToC7 Dibenzofluoranthene 326 ToC7 Heptacyclic PAH, e.g., dibenzoperylene 350 ToC1 Octacyclic PAH, e.g., benzocoronene 352 ToC6 Tribenzofluoranthene (MS. chrom., dist.) 376 ToC5 Octacyclic PAH, e.g., tribenzoperylene Relative' abundance of series. at bottom of valley: 202 > 178 ~ 228 > 252 > 276 > 278 > 302 > 300;.for other samples, see text Structural evidence was derived in all instances from mass spectra, from the chromatographic position, and the relative volatility; "UV" indicates IW'Iher confirmation from ultraviolet spectra. FMSI 05064 Volume 11. Number 12, November 1977 1083  obla:~ed with much improved resolution, demonstrate that automobile exhaust and environmental PAH mixtures are far more comp!tx than was assumed in the past. Therefore, earlier analyses now appear much more limited in their power to correlate with, or to predict, public health effects. Numerous additional components of exhaust and of environmental samples must now be considered in their possible roles as carcinogens, tumor inducers or promoters, and mutagens. The demonstrated correlation between highway traffic and the production of carcinogens strengthens indirectly also the correlation between highway traffic and the observed mortality from cancer. The implications for public health, for city and highway planning, and for efforts to control engine exhaust are considerable. Literature Cited (I) Blumer, W., Jaumann, R., Reich, Th., Schweiz. Rundsch. Med. Prax., 61,514-18 (1972). (2) Giger, W., Blumer, M., Anal. Chern., 46, 1663-71 (1974). (3) Blumer, M., Finnigan Spectra, 5 (3) (19i5). (4) Youngbluud, W. W., Blumer, M., Geochirn. Cosmochim. Acta, 39, 1303-14 (1975). (5) Blumer, M., Sci. Am., 234,34-45 (1976). (6) Blumer, M., Chem. Geol., 16,245-56 (1975}. (7) Greinke, R. A., Lewis, I. C., Anal. Chern., 47,2151-55 (1975). (8) Blurner,M., Youngblood, W. W.,Sciencc, 188,53-55 (1975). Received for review January 3, 1977. Accepted May 26,1977. Work at Woods Hole supported by the Office of Nol'Ol Research (N00- 14-66 Contract C0-241) and the Notional Science Foundation (Grant DES 74-22781). . Determination of Elemental Sulfur by Gas Chromatography John J. Richard, Raymond D. Vick, and Gregor A. Junk Ames Laboratory-ERDA, Iowa State University, Ames, Iowa 50011 11 Elemental sulfur was determined by combining ell!ctron capture detection with cyclohexane extractions of coal, particulate, and soil samples and with resin sorption of water samples. The sensitivity for sulfur Permitted its determination in environmental samples at sub parts per billion levels. The extraction procedures allowed for a minimum of cleanup prior to the rapid and selective gas chromatography. The usual procedures for the determination of elemental sulfur are reduction to the sulfide or oxidation to the sulfate. These techniques gener.ally lack the selectivity and sensitivity of reported gas-liquid (1-7), thin-layer (8), and liquid chromatographic (9) procedures. These are apparently useful for sulfur determinations, but none has been applied to the quantitation of elemental sulfur in environmental samples. This paper describes the methodology for the determination of elemental sulfur in stack particulate, soil, coal, and water samples using gas-liquid chromatography for the separation from other components present in the sample and electron capture for the selective and sensitiVe detection. Experimental Apparatus. A Tracor Model 550 equipped with a Ni 63 electron capture detector (ECD) and a Beckman Model GC-5 equipped with a helium discharge ECD were used for the gas chromatography. Glass columns, 2 m X 4 mm i.d., were packed with the solid supports and liquid phases listed in Table I. These columns were silanized with four injections of 25 ~-tL each Silyl8 (Pierce Chemical Co.) before use. A DuPont 21-490-1 gas chromatograph-mass spectrometer (GC-MS) was used for positive identifications of the elemental sulfur extracted from various environmental samples. Reagents. Cyclohexane (J. T. Baker Chemical Co.), 98% grade, was further purified by distillation. Sulfur standards used for quantitation were prepared by volumetric dilution of a solution having 10 mg of 99.999% sulfur in 50 mL of cyclohexane. The 60-100 mesh Florisil (Floridin Co.) used to clean up the sample extracts was calcined at 540 C by the manufacturer ocand activated for 5 h at 130 prior to use. Analytical Procedures Coal, Particulate, and Soil Extractions. One-gram samples of crushed coal which had passed a 60 mesh sieve were Soxhlet extracted for 24 h. Large 35 X 90 mm glass thimbles were used to prevent plugging of the Soxhlet device by the fines from the coal samples. The 90 mL of cyclohexane used for the extraction were then quantitatively transferred to volumetric flasks and diluted to 100 mL. Five-p.L aliquots of this cyclohexane solution were subjected to gas chromatog- raphy without further cleanup. Particulate samples were collected from 4-in. sampling ports located approximately half-way up the stack of a local power plant. Three types of samples were collected. Particu- lates # 1 were from the accumulation in the ports. Particulates # 2 were collected by drawing the atmosphere from inside the stack through a glass tube containing a glass wool plug. Par- ticulates #3 represented that portion which settled onto horizontal trays placed inside the stack. Ten grams of particulates were extracted in a Soxhlet for 24 h in 25 X 85 rom glass thimbles using approximately 50 mL of cyclohexane. The cyclohexane was transferred to volumetric flasks and diluted to 50 mL with cyclohexane. Five-p.L aliquot& of this solution were gas chromatographed without further cleanup. Ten-gram amounts of local soils were Soxhlet extracted with cyclohexane as above. The extracts were-concentrated Table I. Gas Chromatographic Data for Elemental Sulfur Liquid phaH '"'Solid support" min Column temp, c Flow, mUmln 5% OV-210 11 c 2.3 180 75 4% SE-30/ 6% OV-21011 3% OV-11> 5% OV-11> G 5.2 200 c 1.7 120 c 1.8 120 75 75 75 1.5% OV-17/ 1.95% OV-210" G 2.5 200 160 10% OC-200" .G 3.6 200 160 C Is Chromosorb W HP, 80-100 mesh; G Is Gas Chrom Q, 100-120 mesh. 0 Tracor Model 550; detector. 340 c; injector, 220 "C. e Beckman GC-5; detector, 310 c; injector, 240 c. 1084 Environmental Science & Technology FMSI 05065 TO TCiLE .. U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Center for Disease Control National Institute for Occupational Safety and Health -~":,'-;:".; "': ,, :o":" -~. ~ ~ ... . ...... . :-""',.:{.;;~~:; .!'" .... -.~ 1'": -.~ ' ' !<'~ .~:: ~~,~-,c-. ,. ," -. :a~~~~~~~~~$r'c~:"~-'""''~-~.:~~"~-, ,. ~.r.lo:-...--:'~7' __":".._. ,.,.,,.,,._1'{f''{~"'"""""'-'P1~~~"f'rri'':O::>:f1'i"}~'1f'Z:;~;ioi~L ;?. ~.~. ~ o' , ......~:'~~~---.,,. FMSI 05066 .. A GUIDE TO THE WORK-RELATEDNESS OF DISEASE Marilyn K. Hutchison, M.D., Editor U.S. DEPARTMENT OF HEALTH, EDUCATION, AND viELFARE Publ.ic Health Service Center for Disease Control National Institute for Occupat]onal Safety and Health 1976 F l~t by the Superintendent uf Document. U.S. Government Prlntln& Offh:e. Woahina,:ton. D.C. 20402 FMSI 05067 This Guide is based upon the report submitted in accordance with NIOSH Contract No. 210-75-0075 Project Officers~ Marilyn K. Hutchison~ M.D. Stanley Kusnetz, M.S. DHEW (NIOSH) Publication No. 77-123:. i i I l \ 1 ;; .. FMSl 05068 .. PREFACE The goal of the National Institute for Occupational Safety and Health (NIOSH) is to protect the health and safety of \'/Orki ng men and women. Within the context of this program are NIOSH efforts that are directed toward the identification of those diseas~ conditions that are causally related to occupation, as necessary prerequisite to their prevention. This guide is presented primarily as an aid to State agencies and others concerned with occupational disease compensation. The Guide presents one method for assembling and evaluating evidence that may be relevant in determining the work-relatedness of a disease in an individual. Information on five disease-producing agents is presented to illustrate the decision-making process. It should be noted that such information may not be complete and does not necessarily reflect the most recent data regarding health standards and epidemiologic studies. NIOSH will welcome suggestions for improvement of the Guide based upon experience with its use. .I ' -------- iii FMS\ 05069 ABSTRACT This Guide discusses various factors associated with establishing the relationship between disease and occupation. Prepared as an aid to State agencies, physicians, and others concerned with workers' compensation for occupational disease, the publication describes a method for collecting, organizing, and appraising medical, occupational, and other evidence with the aim of determining the probable work-relatedness of a given disease. Illustrative material on five disease-producing agents is included. The Guide also contains a list of occupations with potential exposure to selected agents, and other information that may be useful to those with decision-making responsibility in cases of occupational disease. iv ' FMSI 05070 .. . ASBESTOS ~-- Introduction Asbestos is a mineral fiber, and is the name given to about thirty silicate compounds. Of these, only the follo\'Jing 5 are of significance in industry: Chrysotile (\'Jhite asbestos) Amosite Tremolite Crocidolite (blue asbestos) Anthophyllite Chrysotile accounts for about 97 percent of all the asbestos used in this country. Asbestos is widespread in the environment because of its extensive use in industry and the home. Over 3,000 products contain asbestos. Because of this wide usage, it may be difficult at times to determine if a disease arising from asbestos is occupational in origin. For example, the air of some relatively new apartment buildings has been found to-contain more asbestos fibers than the w~ximum recommended levels in industry. The source of the fibers in the apartment buildings is the insulating materials used in the ventilating system. Exposure to asbestos can produce a lung fibrosis called asbestosis. The onset of asbestosis is usually gradual, developing over a period of 10 to 30 years of exposure to significant concentrations of asbestos. Occasionally, from very massive exposures, it may develop more quickly. Asbestos is also a cancer producing agent (bronchogenic carcinoma, mesothelioma) and can cause certain specific skin diseases (asbestotic subcutaneous granulomatosis and asbestotic cutaneous verruca). Heavy exposure to dust containing asbestos can cause skin irritation. Epidemiologic studies (experience with groups of people) and aninal studies have shown that increased exposure to any of the types of asbestos increases the risk of lung cancer (bronchial carcinoma). This carcinoma appears to be related to the degree of exposure to asbestos, the type of asbestos and cigarette smoking. It. is also significant that cigarette smoking in men and women greatly increase the risk of lunk cancer in those who are exposed to asbestos. Smoking is a factor that should be considered when determining whether lung cancer is caused, wholly or in part, by an occupational exposure to asbestos. Mesothelioma, a rare malignant tumor of the membrane which lines the chest cavity and the abdominal cavity, is occurrino with increasing frequency in workers with exposure to asbestos. The development of this tumor apparently is not related to the amount of asbestos inhaled and it is found in persons not having asbestosis. Levels of exposure which are within accepted standards for protection against asbestosis, may not ~ 23 FMSl 05071 protect against mescthelicma. ~n increased incidence of malignancy of the stomach and colon has been reported among insulation workers using asbestos. Occupations with Potential Exposure to Asbestos Acoustical Product Makers Acoustical Product Installers Air filter makers Asbestos-cement products makers A5bestos-cement products users Asbestos-coatings makers Asbestos-coatings users Asbestos-grout makers Asbestos-grout users Asbestos-millboard makers Asbestos-millboard users Asbestos-mortar makers Asbestos-mortar users Asbestos millers Asbestos miners Asbestos-paper makers Asbestos-paper users Asbestos-plaster makers Asbestos-plaster users Asbestos sprayers Asbestos workers Asphalt mixers Automobile repair garage workers Brake lining makers Cuilding demolition ~rorkers Carders (asbestos) Caulking compound makers Caulking compound users Clutch facing makers Cobbers (asbestos) Construction workers. 'Crushers (Asbestos) Fiberizers (Asbestos) Fireproofers Firemen Furnace filter makers Gasket makers Heal resistant clothing makers Insulation workers Inert filter media workers Ironing board cover makers laboratory hood installers laggers Paint makers Pipe insulators Plastics makers Pump packing makers Roofers Roofing materials makers. Rubber compounders Shingle makers Ship builders Ship demolition workers Spinners .(Asbestos) Talc miners Talc workers Textile flameproofersTextile workers Undercoaters Vinyl-asbestos tile makers Vinyl-asbestos tile installers Weavers (asbestos} Medical Evaluation (Also, See Decision-Making Process) In addition to the usual medical history, the following should be considered: 1. Any history of diseases of the heart or lung or abnormal tissue growth should be carefully evaluated to determine the relationship between the previous disease and the claimant's present condition. 24 FMSI 05072 .. 2. A respiratory questionnaire, a sample of which is shown in Appendix, can be useful in evaluating the extent and importance of respiratory symptoms such as: .. breathlessness phlegm (sputum) production chest pain cough -- wheezing Asbestosis . Shortness of breath upon exertion is usually the first symptom, frequently accompanied by a dry cough. This symptom develops after several years of progressive pulmonary fibrosis. As asbestosis progresses, the following signs and symptoms are observed: - cough with production of sputum - anorexia (loss of appetite) - secondary respiratory infections that are difficult to control - rapid breathing - repetitive end-inspiratory crackles (crackling sounds heard in the lower part of the lungs through stethoscope when employee ocompletes each of a series of inhaled breaths) - orthopnea (breathing difficulty in a recumbent position) - cyanosis (change in skin color to bluish, grayish, slatelike or dark purple) decrease of chest expansion .I digital clubbing (rounding of the ends, and swelling of the fingers and/or toes) - sequelae (other resultant diseases) including cor pulmonale (right heart failure), branch ogenic carcinoma (lung cancer), stomach or intestinal cancer, or pleural carcinoma (cancer of the membrane lining the chest) Fibrosis results in alveolo-capillary block (impaired ability of the lungs to transfer oxygen into the blood). This impairment is often more severe than is indicated by chest x-rays. - 25 FMSI 05073 Mesothelioma In cases of mesothelioma, the rare malignancy noted above, there may be a long latent period, as much as 40 years, between initial exposure to asbestos and the development of the tumor. Mesothelioma of the peritoneum (membrane surrounding the abdominal organs) is usually accompanied by abdominal swelling and pain that is not concentrated in a particular area. Signs and symptoms of this type of tumor (which may be associated with asbestos exposure) include: - weight loss - obstruction of the bowel - excessive accumulation of fluid in the abdominal cavity (ascites) is almost always present This malignant tumor of the peritoneum may spread to the chest cavity. With mesothelioma of the pleura, complaints include chest pain and breathlessness. Signs and symptoms of pleural mesothelioma include: - pleural effusion (accumulation of fluid in the space around the 1ungs) - the tumor may grow outward through the chest wall in the form of a lump beneath the skin (subcutaneous lump) - the tumor may spread to involve bone, lymph glands (nodes) mediastinum (area between the right and left lungs), and pericardium {t~e sac enclosing the heart). As a result, the supraclavicular nodes may become enlarged, ribs may develop tumors, and obstruction of the superior vena cava {major vein draining the upper portion of the body) may occur. - in addition, pericardial effusion (fluid in the heart cavity) may occur, causing tamponade. Laboratory (See Decision-Making Process) Additional tests which will assist in arriving at a correct diagnosis are: Chest X-rays Findings should be classified according to the ILO/UC 1971 Classification of the Radiographs of the Pneumoconioses. {Appendix B) Findings for asbestosis vary, but the usual picture shows a density in both lungs, with the lower one-third of the lungs involved. In the affected area there is a ~ground glass" appearance. ~ 26 \ FMSI 05074 . As asbestosis progresses, more and more of the lung is involved, except the 1apices (tips of the lungs}. The X-rays will show gradual obscuring of the border between the lungs and the diaphragm. It may-show shadows from the presence of nodules. X-ray findings usually will show the following as the asbestosis progresses: - reduced radiographic volume form~tion of cysts combined with increased size of the heart, dilation (enlargement) of the proximal pulmonary arteries (arteries which lead from the heart to the lungs) Lung Function Tests Reduced lung capacities and other lung changes do not differ from those resulting from other forms of lung fibrosis, both occupational and nonoccupational. Therefore, the results of lung function tests alone or chest X-ray findings alone do not lead to diagnosis of asbestosis. Asbestos bodies in lymph nodes indicate exposure, but no~ necessarily asbestosis. - Asbestosis causes a reduction in the vital capacity (VC) of the lungs and a reduction in total lung capacity (TLC). These capacities are further reduced as the disease progresses. -The residual volume (RV)of the lungs will be normal or slightly increased. -The lungs' diffusing capacity for carbon monoxide (DL) will be reduced. Other lung function test results which are found in asbestosis include: - Increased minute ventilation (amount of air breathed in one minute) - Reduced oxygenation of the arterial blood (arterial hypoxemia) Increased static transpulmonary pressures - Decreased lung compliance An exercise test will result in an increased amount of air required during physical effort, decreased oxygen in the blood, leading to cyanosis. Sputum ExaminatiGn Asbestos fibers or bodies may be found in the sputum. These indicate asbestos exposure, but not necessarily asbestosis. Where cancer cells are present in the sputum, and chest X-ray findings are normal, bronchoscopy may be necessary to confirm and locate the lung tumor. 27 FMS\ 05075 Skin Tests--The following tests should be performed by the physician to exclude possible infectious diseases: 1. PPD (tuberculin test) 2. blastomydn 3. histoplasmin 4. coccidioidin Epidemiological Data Various epidemiologic studies have demonstrated the relati~~ship be!ween asbestos and 1ung disease, including mesothelioma, in su:~ :r~des an~ cccupa~ions as mining, insulation installation, textiles, paint, e1ec~rical ind~stries, and many other occupations as a result of the w~despread use of this substance. The available information indicates evidence of a dase-response re1ationship for asbestos exposure and the risk of asbestosis a~d/cr tronchogenic carcinoma. However, much of this information is epidemiolcgicai in nature and there is little correlation bet\'leen epidemiologi': data c.!'ld envi:o:tmental ex~osure data. Fer th1s reason and others, inclujing the lcng ~atent pe~1od for the development of carcinomas, it is diffic..:lt to deve~cp ;i si)ecific dose-response relationship. This should be taken into considerati0n when referring to the following material: 1 Enterline has reported an exposure-response relationshio between asbestos exposure (evaluated as millions of particles per cubic foot years) and the risk of malignant and nonmalignant r~spiratory disease. Enter!ine's data indicates that the risk of respiratory cancer increased from 166.7 (standardized mortality ratio) at minimum exposure to 555.6 at cumulative exposures exceeding 750 million particles per cubic foot years. Enterline's data is summarized in a table by NIOSH2. Murphy3 reported that asbestosis was 11 times more ccmmon among pipe coverers in new ship construction than in a control group. The first asbestosis was found after 13 years of exposure to an estimated cumulative dose of about 60 million particles per cubic foot years. After 20 years, asbestosis pre~ valence was 38%. ~1urphy reported no asbestosis for men exposed to 60 mppcf years but 20% asbestosis in men exposed to 75-100 mppcf years. Murphy reports atmospheric dust concentrations ranged from 0.8-10.0 moncf depending on the different operations evaluated. Asbestosis was considered present if the worker had at least three of the following: vascular rales in two or more sites, clubbing of the fingers, vital capacity of less than 80% predicted, roentgenography consistent with moderately advanced or advanced asbestosis, shortness of breath on clim~ing one flight of stairs. The Pennsylvania Department of Health4 reported a study of asbestos dust concentrations in two plants (one studies from 1930-1967 and the other from 1948-1968). 64 cases of asbestosis \"ere reported. In the two plants, the study indicates that the air concentrations of particulates were generally less than five mppcf and in many cases less than two mppcf. Epidemiological evidence is also available relating the development of mesothelioma with exposure to asbestos. Selikoff5,6 reported 14 deaths ;I 28 .. FMSI 05076 .. from mesothelioma in 532 abestos insulation workers from 1943-1968. ~eaths from mesothelioma would be expected from the same number of individuals in the general population . Evidence of Exposure . No Historically, there have been two air sampling and analysis methods to determine the quantity of asbestos in the workplace environment. The earlier light field impinger count method allowed only a measure of the overall dust level in the air rather than focusing on the amount of asbestos fibers in the air. The current fiber count method_ satisfactorily determines the amount of asbestos fibers in the air. It is performed by collecting airborne materials on a membrane filter and then counting the fibers using a phase contrast microscope at a 400 to 450 times.magnification ratio (400X450X). Asbestos fibers occur in varying lengths and diameters. As of the publication of the guide, the Occupational Safety and Health Act (OSHA) establishes maximum allowable limits for asbestos fibers greater than five micrometers (urn) in length. OSHA limits such asbestos fibers to no more than five fibers per cubic centimeter of air (based on an eight hour time-weighted average exposure). OSHA further requires that no workers be exposed to more than 10 asbestos fibers (greater than five urn in length) during any one 15 minute period of time. For samples collected by the field impinger count method, results may be compared to the pre-1970 limit (TLV) of five million particles per cubic foot of air. Occupational exposure to asbestos fibers five urn in length or greater, at quantities averaging more than five fibers per cubic centimeter of air or frequent exposures to more than 10 such fibers during a 15-minute period of time is evidence of a possible causal relationship between disease and occupation. Toxicological (See References 1-6, Appendix A) Conclusion The diagnosis of occupational asbestosis is based on meeting the following criteria: 1. Confirmed history of occupational exposure to asbestos. 2. X-ray finding;s compatible with those indicating asbestosis according to ILO/UC 1971 11 Classifi cation of Radiographs of the Pneumoconioses. II 3. Pulmonary impairment, particularly a decrease in lung diffusing capacity and an increase in alveolar-arterial oxygen difference, 29 FMSI 05077 _. as demonstrated by lung function tests. The diagnosis of occupational mesothelioma is based on meeting the following criteria: 1. Confirmed history of occupational exposure to asbestos. 2. Pathological evidence of mesothelioma. 30 . .t FMSI 05078 A-1. TOXICOLOGICAL REFERENCES Asbestos 1. Enterline, P.; et. ~1. A Study of the Dose-Response Relationship Asbestos Dust an~Luno Cancer. Unpublished manuscript. 2. NIOSH. 1972. r.riteria for a Recommended StandardOccupational Exposure to Asbestos. (incinnati: NIOSH 3. Murphy, R.L.II.; et al. 1971. N. Eng. J. Med. 285:1271. 4. Pennsylvania Dept. of Public Health. Unpublished Conmunication. 5. Selikoff, I..l.; et al. 1968. JAf~A. 204:106. 6. Selikoff, I.J.: et al. 1964. JAMA. 188:22. Carbon Monoxide 7. NIOSH. 1972. Criteria for a Recommended StandardOccupational Exoosure to Carbon Monoxide. Cincinnati: :nosH. 8. Sayers, R.R.; et. al. 1929. USPHS Bull. 186. Washington: r,po. a. '1cFarland, ~-" 1944. J. Aviation Med. 15:381. 10. Halperin, 'tH.; et al. 1959. J. Physiol. 146:583. 11. Horvath, S.M. 1972. ~rch. Env. Health. 23:343. 12. Schulte, J.H. 1963. '\rch. Env. Health. 7:524 13. Beard, R.R.; and Hertheim, '>. 1967. Am. J. Pub. Health. 57:2012. 14. Beard, '1..~.; and Grandstaff, N.~J. 1970. Proc. Ann. Conf. Env. Toxic. 1:Q3. 15. Trouton, D.; Rnd Eysewck, H.J. 1~61. Handbook of Abnormal Psycholnqy. New York: Basic Books. 16. NIOSH. 1972. Criteria for a Recommended Standard - Occ~pational Exoosure to Carbon ~funoxide. Cincinnati: ~HOSH. 65 FMSI 05079 Lead 17. Elkins, f!.D. 1959. The Chemistry of Industrial Toxicoloqy 2nd ed. 'lew York: John \~il ey. 18. Lane, ~.E. 1949. Brit. 1. Ind. '1ed. 6:125. 19. ~lil1iams, ~~.K.; et a1. 1969. Brit .1. Ind. Med. 26:202. 20. IHOSH. 1972. Criteria for a Recommended Standard Occupational Exposure to Inoraanic Lead. Cinc1nnati: ~HOSH . 21. Hartogenesis, ~.;and Zielhuis, R.L. 1962. Ann . Occ. Hyg. 5:27. 42. Dreeson~ lf. C.; et al. 1941. Pub1 ic U~alth Bulletin 262. '-'ashington: GPO. 23. National Academy of Sciences~ Division of Medical Sciences, Committee on Biological Effects of Atmospheric Pollutants. 1971. Airborne Lead in Perspective. ~~oi se 24. :!JOSH. 1972. Criteria for a Recommended Standard Occupational Exposure to Noise. f.incinnati: NIOSH~ 25. Coles; and Knight. 1960. 1\nn. nee. H~g. 2:267. 26. Yaffe; and Jones. 1961. u.s. Public Health Service Publication 850. Washington: r,po. 27. Schneider: et al. 1961. 1\IHA J. 22:245. 28. Brahm; and Z1amal. 1962. Cas. Lek. Ces. 101:300. Czech. 29. Mancini; and Stancari. 1962. Dass. Med. Ind~ 31:239. Italian. 30. Chad\vick. 1963. J. Larynqol. 77:467. 31. Filin. 1963. r,og. Tr. Prof. 7abol. 7:3. Russian. 32. 11eston. 1963. 1. ll,us. Inst. Agr. Sci'. 29:15. 33. Cohen; et a1. 1970. 1\rch. Env. Health 20:614~ 34. Burns; ~nd Robinson. 1970. Hearing and ~oise in Industry. London: ller Majesty's Stationery Office. 35. Stone; et a1. 1971. '\IHA J. 32:123 66 . FMSI 05080 .. Toluene Oiisocyante 36. fHOSH. 1973. Cl'iteria for a ~ecommended Standard Occuoationa1 Exposu;-e to Toluene Diisocyanate. Cincinnati: NIOSH. ~37. Walwor.th, IL T. ; and Vi rchow, !!.E. 1959. AIHA J. 20:205. 38. Elkins, H.!L; et al. 1962. AIHA J. '23.265. 39. r,lass, ''I.; and Thorn, N.G. 1964. ~I.Z. ~4ed . .J. 63:642. 40. Hil1iamson, K.S. 1964. Trans. 1\ssoc. Ind. ' 4ed. "ff. 14:81. 41. Maxon, F.C. 1964. ~rch. Env. Health. 8:755. 42. Bruckner, H.C.; et al. 1968. '\rch Env. Health. 16:619 43. Peters, J.M.; et al. 1968. ll.rch Env. Health. 16:642. I I I 67 FMSI 05081 A-2. BIBLIOGRAPHY Asbestos 1. Arena, J.M. 1970. Poisoning, Toxicology, Symptoms, Treatments. Springfield: Charles C. Thomas. 2. Council on Occupational Health. 1963. ~rch. Env. Hea1th. 7: 130. 3. Hamilton, A.; and Hardy, H.L. 1974. Industrial Toxicology. 3rd eo. Acton: Publishing Sciences Group. 4. Morgan, W.K.C.; and Seaton, A. 1975. Occupational ~ Lung Diseases. Philadelphia: 1-!.11. Saunders. 5. Advisory Committee on Asbestos Cancers. 1972. The_Bio1ogical Effects of Asbestos. Delivered to World Health Organization, Lyon, Oct. 5-6. I 6. NIOSH. 1972. Criteria for a Recommended Standard Occupational Exposure to Asbestos. Cincinnati: NIOSH 7. Yater, l~.M.; i'l.nd Oliver, I. F. 1961. ~motam Diaqnosis. 5th ed. New York: Appleton Century Croft. 1 Carbon Monoxide l. ~nOSH. 1973. Criteria for a Recommended Standard ~ccupationa1 Exposure to Carbon Monoxide. Cincinnati: NIOSH . . 2. Gafafer, W.M. 1966. ~ccupational Diseases.A Guide to their Recognition. Washington: !I.S. flovernment Printing Office. 3. Breaker, W.; and Mossman, A.L. 1970. Toxic Gases: First Aid and Medical Treatment. Rutherford: Matheson Gas Products. 4. Hunter, D. 1969. The Diseases of Occupations. 4th ed. Roston: Little, 8rown. 5. '\rena, .1.~. 1970. Poisoning, Toxicoloqy, Symptoms, Treatment. ~orinafie1d: Charles C. Thomas. 6. Plunkett, E.R. 1966. 'landbook of Industrial Toxicoloqy. Ne\v York: Chemical Publishing. ! 68 J -~ FMSI 05082 '\ \ C. SAMP~ RESPIRATORY QUESTIONNAIRE Use the actual wording o~ each question. Put X in the appropriate space after each question. When in doubt. record "NO." PREAMBLE: I am going to ask you some questions mainly about your chest. I should like you to answer 'YES' or 'NO' whenever possible. YES NO 1. Do you usually cough first thing in the morning or on getting up? (Count a cough with first smoke or on first going out of doors. Exclude throat clearing or a single cough.) 2. Do you cough like this on most days for as m~ch as three months each year? 3. Do you cough at work? 4. Do yc-u usually bring up some phlegm from you~ chest first thing in the morning or on getting up? (Cou~t phl~gm with the first smoke or on-first going out of doors. Exclude phlegm from the nose. Count swallowed phle?,tu.) / / 91 FMSl 05083 5. Do you bring up phlegm like this on most days for as much as three months each year? 6. In the past three years, have you had ' a period of (increased) cough and phlegm lasting 3 weeks or more? 7. Have you had more than one such period? 8. Does your chest ever feel tight or your breathing become difficult? 9. Do you get this apart from colds? (If YES: specify (Interviewer to code) (a) With Exercise (b) At Work (c) Any Other Time If disabled from walking by skeletal or other physical disability put 'X' here. 10. Are rou troubled by shortness of breath. when hurrying on the levels or walking up a slight hill? (If 'NO' omit questions 11 and 12) 11. Do you get short of breath walking with other people of your own age on level ground? (If 'NO' omit question 12) 92 .. .t FMSI 05084 --~ -- - -. --- ' --- - .. U. iJ)0 ~ 1US0~l.'9" h&v~ a stuffy nose or lt:al~ <a.l: 1tll& baek of your nose i.n 'the :n_t4.. b ~ ~ 1thl..s i:n the SlDillller? (B:jf 11:!NO'' 1tCill '!!Dot:b ques~:ions 13 and 14, --~ -ttro ~~:ii.IZ1m ]:6) 113i.. IDo )'IDm ~ 1thl.s on most days for as much JlfD- llllDm::ii:n;g tt:me ~ 3 years have you had any .a::ful;$:t i!]]jl!\Pss vJrl.ch has kept you off work amr :lfmmm ~ nSII!lal activities for as much Jl71.. 1Dliid:1 ~ ib::r::fumg 1lliP 11Jl:Dre phlegm than usual ]1$.. ruavce ~ illla!il mwre than one illness with l(t~ ~ ~his in the last 3 years? ~~~ ~~~v~~t ~~il after each positive answer.) ~.. 100 ~"~ t1'~ ~~ation affecting your 93 FMSI 05085 21. Bronchitis? 22. Pneumonia? 23. Pleurisy? 24. Pulmonary Tuberculosis? 25. Bronchial Asthma? 26. Eczema? 27, Dermatitis? 28. Pneumoconiosis? 29. Byssinosis? 30. Other chest troubles? 31. Have you ever smoked? (Record 'NO' if subject has never smoked as much as one cigarette a day, or 1 oz. tobacco a month, for as long as one year). 94 \ FMSI 05086 32. Age when stopped._ ____,years. Was this in the last month? If 'YES' to 31 and 32, fill in figures below: Cigarettes/day (Average including weekends) AMOUNT SMOKED BEFORE NOW STOPPING Oz. tobacco/week (handrolled) Cigars/week (large) Cigars/week (small) OCCUPATION (1st Interview Only) (Record on lines the years in which subject has worked in any of these industries, e.g., 1960-1963) 33. Have you ever worked in a dusty YES NO job? 34. In a coal mine -------- 35. In any other mine? 36. In a quarry? 37. In a foundry? 38. In a pottery? 39. In a cotton, flax or hemp mill? 40. With asbestos? 95 FMSI 05087 41. In any other dusty job? If 'YES', specify ------- 42. Have you been exposed regularly to I irritating gas or chemical fumes? If 'YES' give det.ails of nature and duration ------------------- OCCUPATION (Follow-Up only) 43. What is your present job? ----------------------------44. How long have you been doing it? 45. What was your previous job in the factory? - - - - - - - - - Taken with minor changes from Operating and Medical Codes of Practice for Safe Working with Toulene Diisocyanate, Health .~visory Committee, British Rubber Manufacturers' Association Ltd. 96 .. FMS\ 05088 Y ~ ., 3: !!1 0 (11 0co (D " '- ~ ....__ ~v\ ~ .?cJ' ~ ;:_.l. ASBESTOS: THE PHOENIX OF OCCUPATIONAL MEDICINE* Harvey B. Snyder, M.D. EXXON COMPANY, U.S.A. .. The Phoenix was a large sized, male, fabulous mythical bird with a sweet voice and gorgeous plumage. It was sacred to the Sun, was thP. only one of its kind and lived for a long time. At the end of its life it made .a nest of the twigs of spice trees on which it died by setting the nest on fire and burning itself alive. From its body or its ashes or the nest which it had fertilized came forth another phoenix, perfect, but first in the shape of a white grub. The young bird, as soon as it was strong enough, took up the charred and all body of and flew i~tos father, covered itself in spices, took ashes, nest Heliopolis in Egypt where it deposited them on the altar of the Sun. It then died, but not before spontaneously producing an offspring. This significant symbol of immortality, albeit totally legendary, has a distinct relationship to the magic mineral asbestos which has been said to have a half-life of infinity. Asbestos has been called the 20th Century mineral for its produc tion and utility has increased 20 times more than petroleum in the past 60 years. This is startling when we recognize that the mineral is practically indestructible and is capable of producing disease after a period of 20 or more years after exposure. Is the prediction6 of in creasing incidence of asbestosis in the future exaggerated1' .Asbestos was known to the Ancient World. Plutarch refers to the ..perpetual" lamp wick.; used by the Vestal Virgins. Pliny writes of a shroud for cremation of nobility and calls asbestos "the funeral dreAs~sbeosftkosinguss"e.for modern industry was begun in 1868 when 200 tons were produced in Italy. .The mineral is of two varieties. Pyroxene is a serpentine fiber, an example of which is chrysotile, and is the bulk of commerical asbestos used. Amphiboles represents the second variety of asbestos and is represented by crocidolite, amosite, anthophylite, tremolite and actinolite. Prcaented at the European Medical Directora Meetina, Brunell, Belaium, l976. 2' i=z=r- .. ...-..,,~-~~ . .--~- ---~7"":~-----.-.--- -..:_-.:-._ ~,,.,_.~_ .. -~ = '""u~~---- '"" THE MEDICAL BULLETIN The world ;Jroduction is increasing annually. The largest commercial produc:er is Canada, which has approximately two-thirds of the total world production. Ctocidolite, or "blue asbestos", is mined in South Africa and Australia. Amosite is found mpstly in South Africa. The largest United States production is in Maryland and California. This variety is anthophylite, (MgFe),Si~Oi2(0H)~. which has long coarse fibers of low tensile strength and thus of little commercial importance. Most varieties of asbestos have these elements present in their chemical compostion. Physical Characteristics of Asbestos Fibers Asbestos has an almost infinite ability to subdivide itself into smaller afld more fibers. Asbestos fibers may be 2 inches or more in length but their attrition is unavoidable when separating fibers from non-fibrous rock. This results in fibers so short that the length is hardly greater than the diameter. Similarly, the diameter of bunches of fibers may be 1/32" or more in fairly crudely processed specimens but break down to 100-1000 particles- many too small to be counted with the optical microscope. In an air stream a fiber is generally unpredictable since, rather than conforming to the direc. tion of motion like an arrow, it may spin round and round, collecting other fibers to it forming balls of fluff. In addition, asbestos fibers may divide incompletely at the ends, forming "parachutes" that stay suspended in the air. The size of the fiber is critical. Recent studies haveshown that fiber penetration of the lung depends on "diameter and curliness". Harshness thus may be important as it may affect the ability of the fiber to curl. There are many classifications of diseases of the respiratory system. Asbestos fits into the causative scheme of clinical lung disease as a producer of a type of pneumoconiosis and is also a cause of malignant disease of the lungs and pleura. Clinical Asbestosis The characteristic feature of asbestosis is diffuse pulmonary fibrosis (alveolar-capillary block), which contrasts strongly with the . nodular fibrosis of silicosis. As a rule, the lesions of asbestosis are most pronounced in the lower and middle lung zones, whereas emphysema often predominates in the upper zones. In addition to these parenchymatous changes, asbestos often causes a proliferation of the connective tissues in the visceral pleura, particularly in the basal and medial regions. There is no correlation between the ., 3: ~ 0 CJI 0 CD 0 , ..,... __,._, _ _ _ _ _ __ ASBESTOS: THE PHOENIX OF OCCUPATIONAL MEOICIHE I severity of pulmonary fibrosis and the pleural changes. Severe pulmonary fibrosis may be present without pleural lesions and severe pleural changes with only mild pulmonary fibrosis. ln progressive asbestosis there may be gross pleural thickening with horn-like plaques giving the roentgenogram a highly characteristic appearance. Calcified plaque formation, when bilateral, is said to b~ pathognomonic of asbestosis, but it does not necessarily develop into the malignant changes o.F-mesothelioma. Theories of Pathogenesis 1. The Original Theory of Physical Irritation The preser.ce of the asbestos fibers in the terminal spaces causes irritation and damage to the walls of the alveoli, leading to fibrosis. 2. The Solubility Theory The fibrosis is due to the effects of the silicic acid and metal ions leaching out from the asbestos fibers. Asbestos is relatively more soluble than quartz and coal. 3. The Autoimmune Theory Two concepts are entertained: a. The presence of the asbestos in the lungs and its reaction within the alveolar phagocytes or fibroblasts either produces or localizes abnormal globulin, the presence of, which l.an be discerned by the presence of"rheumatoid fac: tor" in the circulating blood and in the tissues by immunofluorescent techniques. b. The effect of the fiber on the pulmonary phagocytes combined with their being entrapped in the respiratory bronchioles may be a factor in the initiation of fibrosis. The lysis, then, of the phagocyte at this site releases a "substance" that is not accepted as "seir. 4. Stagnation of Phagocytes Theory This is similar to (3.) but involves no immunologic mechanism in .the tissue destruction and fibrosis. The trapped phagocytes . disintegrate and release sclerosing agents, lipids and lipopro~ teins. THE MEDICAL BULLET.1N Pathology Asbestosis occurs in two main anatomical forms: I. Diffuse Fibrosis- honeycomb (cystic) lung 2. Solid Fibrosis In either case there appears to be first an aggregati~n of macrophages in the alveolar spaces, followed by a desquamation of the lining epithelium. Asbestos fibers coated with hemosiderin (asbestos bodies) may be seen in a period as short as 16 days after exposure. The characteristic lesion in asbestosis is the asbestos body, more appropriately called the ferruginous body. J. 4. 10 Asbestos Q.bers, unlike shorter particles called asbestos dust, are converted into asbestos bodies (ferruginous bodies) by deposition of yellow globules of protein and iron, producing an easily recognized and quite characteristic structure. But, before this happens, many of the thin and sharp asbestos fibers move downwards to the lung bases owing to lung movements and to gravity. This downward movement is likely to be more efficient and more rapid in the healthy lungs of the active young. Once a fiber has become a ferruginous body it is unlikely to move further, as it is usually too large to be phagocytosed or transported by lymphatics and its sharp points are now blunted by the protein globules. In recent years the term asbestos body has been altered by some to "asbestosis bod)"'. This is an unfortunate and unwarranted change, because the great majority of lungs which show asbestos bodies have no pulmonary asbestosis at all, as the findings of many studies clearly demonstrate. This supplies a good reason to call the unique pathological lesion a ferruginous body. Recently Dr. L J. Selikoff has stated that virtually :,100% of New York City adults have ferruginous bodies. Others5 have also made this assertion. Fortunately there is far less incidence of asbestosis.6 There is today an increasing amount of evidence suggesting that less intense grades of pulmonary asbestosis an.d even minor or trivial amounts are more likely to be associated with pleural rather than with pulmonary changes. Pleural thickening associated with asbestosis is usually calcified and has a significant frequency of malignant mesothelioma of the pleura or the peritoneum. 24 "TT 3: -CJ) e0n 0 U) ..a. OF OCCU-PATIOlfAL Mt!Utwnu:o There is a prediction of an increase of limited basal asbcs1os.is. malignant mesothelioma of the pleura, and mesothelioma of the peritoneum. Signs and Symptoms The predominant symptom is dyspnea. This is not surprising in view of the earlier statement that the basic pathophysiology is an alveolar-capil\ary block. Asbestosis may also present with signs and symptoms of pleural effusion.6 7. s Lung function tests9 are highly characteristic and constant, including: 1. Small inspiratory capacity. 2. Decreased MBC but well maintained relative to lung volume. 3. High FEV1 relative to vital capacity. 4. Reduced vital capacity. This is the most sensitive index of the progression of the disease. 5. Reduced diffusing capacity. 6. Loss of compliance. 7. No significant changes in blood gas studies. Radiological Findings' 1. 1nterstitiaI fibrosis. 2. Pleural thickening-plaques. 3. Basal findings >Apical findings. 4. Obliteration of the costophrenic angles. s. Shaggy cardiac shadow. 6. Thickening of interlobar septa. 7. "Ground glass" appearance, composed of linear markings and small discrete opacities in the lower lobes. 8. Honeycomb appearance just above the diaphragm. In one study of asbestosis with 1117 cases, there were ISOcaHs of pleural plaques. They were found tot more prevalent on the left side. When calcilicalion was ellteMive il was usually bilateral. Cakificatic usually involved the parietal pleufl primarily. Calc:irlcation of plaques correlated to an uposurc of mat year1 before, oftcn 20 or more.  , , a .., aS rrvlfl1S"-...-- l. Distinction between asbestosis and other forms of diffuse fibrosis. Scleroderma Idiopathic diffuse interstitial fibrosis . Cystic lung- pneumoconiosis Eosinopr.ilic granuloma Sarcoidosis Solid fibrosis- M.P.F. 2. Distinction between other forms of silicatosis (nodular whorled fibrosis) 3. Distinction between ferruginous bodies and hemosiderosis of elastic tissues which may mimic asbestosis. Rheumatoid asbestosis. In summary, there are a number of short "clinical pearls" which were gleaned from a course on Environmental Lung Disease, given in New York City, 10-12 June 1976. 1. The latent period in asbestosis is long - >20 years. 2. A single exposure may be causative. This gives some credencr to the concept of "Bystander's Disease". Laws of dose-response are not necessarily followed. . 3. Lung cancer is seldom seen in asbestos workers who do not smoke. It is 92 times more frequent in smokers. 4. Smoking is not related to mesothelioma.'' S. Air pollution is not a significant factor in cancer of lung. 6. Compared to non-smokers with the same disease a. Fifteen times as many cases of emphysema are smokers b. Ten times as many cases of cancer of lung are smokers c. Two times as many- 'cases of coronary artery disease are smokers 7. Eighty-five percent of mesotheliomas have a history of asbestos exposure. 8. Sputum cytology is positive prior to any x-ray evidence of carcinoma of lung. While the first cases of pulmonary fibrosis caused by asbestos inhalation were reported in 1929, 12 and the first case of lung cancer associated with asbestos was reported in 1935, 1J' it was not until !8. '" ., 3en: 0 Ul 0 CD N 1(}6814 thafep1demiologTcs11Idlesesunmsneo 1.1n:TUiv VI a3oc;acou ,_, the development of lung cancer in cigarette smoking asbestos workers. We should remember a point which Professor Ted Hatch has emphasized on several occasions, "When the dust levels are very high, almost any measurement is good enough to show a chamge for the be':ter. But when the dust levels are getting low but not low enough, much more attention must be given to using those measure ments which are biologically most appropriate." This is almost cer tainly the position we are likely to have to face in controlling the asbestos dust hazard in the future. REFERENCES I. Gibbs, LeChance, Chrysotile Mine Dust Exposure in Canada, Arch. En..,iron Health. March 19:72. 2. Bruce, T., Occupational Diseases of the Respiratory System, Scan~. J. Resp. Dis. 63(Supp): 73, 1968. 3. Greenberg, S. Donald et al, Sputum Cytopathological Findings in Former Asbestos Workers, Texa.r Medicine 72:39-43, 1976. 4. Gaensler, E.A., Addington, W.W., Asbestos or Ferruginous: Bodies, N. Eng. J. Med. 280:488-492, 1969. 5. Langer, A.M. et al, Chrysotile Asbestos in the Lungs of Persons in NYC, Arch. Environ. Health 22:348-361, 1971. 6. Leuallcn. E.C.. Carr; D.T;; Pleural Effusion Study of 436 Patients, N. Eng. J. Med. 252:79-88, 1965. 7. Oaensler, E.A., Kaplan, A.l., Asbestos-Pleural Effusion, Ann. Int. Med. 74:178-191, 1971. 8. Lowrie, E.G. Asbestosis-Pleural Effusion, Ann. Int. Med.: 83:735, 1975. ' 9. Bader, M.2., Bader, R.D., Terstejn, A.S., Pulmonary Function and Radiographic Changes-598 Workers with Varying Degrees .. of Abestosis, Mt. Sinai J. Med., 37:492500, 1970. 10. Suzuki, Y., Churg, J., Asbestos Body-Structure and Develop ment, Am. J. Path., 55:79-107, 1969. 11. Editorial, Asbestos-.Lung Cancer... Mesothelioma, Lance, 1:815, 1973. 2. ... THE MEDICAL BULLETIN 12. Cooke, W.E., Fibrosis of the Lungs Due to Inhalation of Asbestos, Br. Med. J., 2:578-580, 1929. 13. Lynch, K.M., Smith, W.A., Pulmonary Asbestosis: Carcinoma of Lung in Asbestos Workers, Am. J. Cancer 24:51-64, 1935. 14. Selikoff, I.J. et al., Asbestos Exposure, Smoking and Neoplasia, J.A.M.A., 204:106-112, 1968. 15. Biological Effects of Asbestos, Ann. N.Y. A cad. Science, 132:338', 1965. 16. Selikoff, I.J. et at, Asbestos and Neoplasia, Am. ..'. Med., 42:487, 1967. -n -3en: 0 (J1 0 CD (,.) 28 ~ .. lHE MEDICAL-BULLETIN 1: of Adequate signs must be posted in areas where asbestos is being used or disturbed. These notices should clearly state that a potential health hazard exists and that personnel should avoid the area unless they are wearing necessary protective equipment. " fl!. ; ! .\ I ri ! Acceptable housekeeping procedures must be instituted to minimize the spread of contamination where asbestos- containing materials are being handled. Such procedures EXXON ASBESTOS CONTROL RECOMMENDATIONS* include such steps as adequate wetting of the materials hefore sawing or otherwise disturbing old insulation, the use of IEXXON CORPORATION e i' IAlthough the importance of eliminating asbestos from new con- vacuum equipment to collect finely divided material, the use of plastic drop cloths, the collection of debris in plastic bags and the burial of old material in adequately marked disposal areas. A monitoring program should be established to assess exposures to asbestos at regular intervals. struction and of minimizing exposure to "old asbestos" has been . emphasized in both formal and informal communications between ~ Employees who are or have been potentially exposed to the corporate and regional/affiliate medical departments, no for- ~ mal policy statement has been issued at the corporate level. In spite of the existence of different local regulations and a recognition of '"' asbestos should be identified and included in a medical program including a yearly chest x-ray to determine if adverse health effects are occurring. the influence of local customs and economic factors, the need for a corporate position seems evident. Exposure to asbestos must be ~( A hazard information sheet should be developed to instruct employees who have to work with asbestos-containing eliminated or reduced to minimal levels by eliminating its use in , materials about the potential health effects of the material and new construction where possible and establishing procedures for the handling of'asbestos~containing material already in use so there is ,, no health risk to employees or others. IThe rollowing recommendations are issued ror the guidance or all preventive measures in effect. . Contractors and their employees who have to work with asbestos-containing materials should be provided with the same information given to Exxon employees and should_ be regional affiliate management and medical personnel: ...,. required to adhere. to the same protective work practices, Th't:ir Non-asbestos containing materials should be used in all new t~ compliance should be assured by adequate monitoring. construction unless their use would create a greater health and .: safety hazard by failure to meet insulating requirements. The Research & Environmental Health Division, Exxon ~ f'Medical ~epartment, has and wil.l ~aintain and uis.tribute an updated list of non-asbestos contammg products available on a "11 3: CJ) w~xoirsltd~nwgiduenitbsassihsouolrd ibnesspuercviefiycedopbeyramtain~gntaerneaansc.e per~onnel t.o tdenllfy where asbestos was used 10 pnor constructiOn. Thts :~~~ e0n 0 will enable exposure controls to be instituted when these units 1 are to be worked on and there is the possibility of a release of : CD ,Jilo asbestos fibers. :. ' be available to emploxees who have to work on units when and where exposure to asbestos is a risk. : i30 . Issued September 9, 1976. W : ' ~. ;, ~ -;:: - :::in *JMOi u:: ':~wai.t ;re:e:rm:r@. :::lht!/SAf!:!;'S-tttr::t::::z:t :::=tt\1':::;::~= .z ; :I::::::.::~:::rI; z :;.r;;:'"'~.~::.e~:..t.. '- -!-! .f~. ~..t. :,.,,:4.4..,-_-__~~,.,.~~.-~;:;~;~~~" 'ti I '6 ..,., 3: ~ 0 '"0 U) '" ASBESTOS HANDLING PROCEDURE* Asbestos fibers have been deemed a serious respiratory hazard and control of worker exposure is considered necessary to prevent asbestosis and asbestos-induced neoplasms. Various Exxon affiliates have taken positive action limiting the use of and requiring substitutes fo,r asbestos-containing materials including talc, asbestos insulation materials (all high temperature insulation can be assumed to be asbestos or contain 5% or more asbestos as a binder), asbestos fire blankets, etc. However, asbestos has been used for many years and its presence will be noticed each time insulation must be removed, during turnaround work and sometimes in new construction when asbestos insulation is the only suitable material. At scheduled turnaround, the breaking of insulation and reins~:lling same after piping completions, etc. will entail some el'.posure to asbestOS fibers. Despite the existence of widespread knowledge concerning the potential health hazards of this material, there is significant variation in control measures in effect at the operating affiliates. As a result, Exxon Corporation Medical Department has issued a Policy on the control of asbestos as a guide to the elimination or reduction to minimal levels in the use of asbestos in new construction where possible and to establish procedures for the handling of asbestoscontaining n:aterial already in use. The following work practices are recommended: (1) Asbestos-containing cements, mortars, coatings, grout and plaster should be mixed in closed bags or other containers. Manufacturers have high temperature mortars packed in plastic bags .so that water can be added directly to the bags through a spout and moistened before opening. Moistened mortar is removed as required and mixing is completed in the shipping container. All waste is replaced in this container and sent to disposal at the end of the shift. THE MEDICAL BULLETIN (2) Removal of asbestos insulation or ripping-off procedures must be done in a manner which will minimize scatter, dusting or dispersion of asbestos. After removing the wire clips and bands hofding the jacket, and the jacket from the insulation, the su.-face insulation should be wetted. A plastic sheet placed below the piping or structure \'Jill serve subsequent clean-up. As many large pieces should be removed as feasible to minimize the number of cuts required. (3) All waste insulation should be placed in dust-proof bags and all clean-up of asbestos dust shall be performed by vacuum cleaners or by wet cleaning methods. No dry sweeping should be allowed. (4) There should be no spraying of asbestos material without precautions to limit the spread of overspray. (5) Where possible, restrict movement into areas where asbestos dust is being generated by roping and signs which read "Keep Out-Authorized Entry Only." (6) Special protective clothing should be provided to employees working in areas where asbestos dust is being generated. Care should be exercised in laundering and other handling of contaminated clothing. Effective July 1, 1976 the OSHA time weighted average (8-hour) standard for asbestos is 2 fibers(> 5~m in length) per ml of air. A 15-minute ceiling limit of 10 fibers (> 5~m/ml) also applies. Since air monitoring may not always be possible the approximate guide in Table II has been prepared as an aid to respirator selection. However, whenever there is any doubt whether these recommendations are adequate or where air monitoring data is available, respirators should be selected to insure that exposure does not exceed recommended standards. . Air monitoring techniques to determine concentrations recommended in the standard require some sophisticated equipment and skill. Accordingly to minimize exposures, a series of procedures are recommended in lieu of air monitoring. These are as follows: All persons within the work area shall wear personal respiratory protective equipment selected on the basis of potential airborne concentrations of asbestos dust exceeding a TWA limit of 2 .fi.l:lersjml as time weighted average with a ceiling limit of 10 fibers/mi. 32 "sT:1: ~ 0 (11 0 CeDn ASBESTOS HANDLING PROCEDURE Respirators supplied for the specific application should be' cleaned or disposed, maintained and serviced regularly. When not1 in use they should be stored in dust proof containers, e.g., a scaleq plastic bag. I The following recommending classification has been appropriate respirators adopted for the fotyrpteheopfuarpsboessetoo4~ material involved in each operation (See Table 1). ' Table 1. Classification of Asbestos Containing Materials Oroup I Oroup II Oroup Ill OroupiV QroupV (Applied dty) Molded asbestos Motded calcium aJJJcate/aabestoa Molded magnesia (85'/o) Molded high temperature Jnaulatlng block (Applied wet) Calcium silicate (plastic) 85% magnesia (plastic) Hard-setting asbestos cement Sprayed asbestos Cement asbestos (hard) Rooting sheets Drain p1pes Building boards Asbestos rope, yarri tapa and aeallng material (notlmpregna\ld) Asbestos blankets and clothing Asbestos mlllboard and paper Flltar mats and gauzes Raslnbond.ed and asbestos reinforced material (e.g., friction linings and alectrlcallnaulatlng rilaterlala) Asbestos gland packing (Impregnated) Compressed fiber )olnllng Gaskell and preformed packing Table 2. Respiratory Protection Equipment Selection Guide Operation Spraying/Demolition (ConHned apace) Tearing Out Insulation (ConHned apace) (Outdoor') Rttplratory Protection R~ulred Dry Operation Wal Operation' Type of Aabeatoa Material Uaed With Vent. No. Vent. With Vent. No. Yen 1,11 0 D c D 1,11 c c D c c Fulllace B c c ~: THE MEDICAL BULLETIN Operation 'Housekeeping (Confined space) .Sweeping . Vacuuming (outdoor) Sweeping Vacuuming Application (Confined space) (Ouldoor) Material Handling (Confined epace) Mixing Wasta dlspoeal Charging (Outdoor) Mixing Waste disposal Charging Grinding & Sanding (Confined spece) (Outdoor) CuHing & Drilling (Confined space) (Outdoor) CuHing & Drilling (Confined apace) (Outdoor) Bending & RlvaHing (Confined space) (Outdoor) Application (Confined space) (Outdoor) Table 2. (Continued) Respirelory Protecllon Required Dry Operation Type of Aabestoe Material Uaed With Vent. No. Vent. Wet Operation' With Vent. No. Vent. All groups All groups All group~ All groups All groups 1,11 t,ll c Full!ace B Full!ace B A orB Full!ace B A orB 0 c Fullface B Fulllaca B c Fulllace B Fulllace B AorB B A orB c A'orB B A orB Fulllace B Fullfaca B A orB A orB t,ll 1,11 1,11 1,11 All groups 1,11 III,V III,V IV III.V III,IV,V Fuillace B CorD A orB Fulllace B or C Fulllace B CorD A orB A orB B c Fullface B Fulllaca B A OrB A orB c AorB A orB A orB A orB A orB A orB A orB None None None AorB None None None None Nona Nona None A orB A A orB A ?r B None None None None None None None None A orB A orB A orB A orB A or 8 A orA A orB A orB None Nona None Nof111 None None A- Single use 'li lace respirator with or without exhalation valve B -Air purifying 'h lace respirator with replaceable particulate filter C- Powered air purifying respirator, with high elflclency lUter 0 - Supplied air respirator with full laceplece, continuous flow or pressure demand Notee: 1 - Refers to any operation performed outside any confined space where natural ventilation Is available 2- Ventilation refers to any mechanical exhaust or dilution unit. When applied to "outdoor" II relers to mechanical ventilation In addition to already present natural ventilation. 3 - This Implies a thorough soaking of the material before any operation Ia begun. Superficial weHing will not provide adequate control. 3<4 -n -3: (/) 0 en 0 ~ ""gc;...,' ..,.., ......-.--.--- The following respirators or their equivalent are recorrimcndet:l for use when working with asbestos containing materials. ' . A. Single Use Respirators (Disposable) Manulaclurer 3M Willson A.O. Safellne 3M Model Number 8710 1400 R1050 5350 8800 - B. Air Purifying Respirators with Replacement Fllter (Reusable) Manufacturer MSA MSA Willson Willson Willson A.O. 1.. 0 . Sa feline Welsh Welsh Cover CESCO Glendale Model Number 459440 459438 560 1210 1211 R5030 R6030 5265 7506 7406L 1482-F100 94R20 GR2000 Replacement Filter 459595(10) 459321 R60 R10 R11 R30 R30 5905 7500-6 7400-6 F100 R20 F10 ~ c. Supplied Air Respirators With Full Faceplece Manufacturer SurvlvAir 3M Scott MSA Pulmosan Willson Bullard A.O. Lear Siegler Model Number 9011-13 9811-13 W840 4616-11 801548 460862 A480110168 1810 46 R6099 0501A Operating Mode Pressure demand Pressure demand C'ontlnuousflow Continuous flow Pressure demand Continuous flow Continuous flow Continuous flow Continuous flow Continuous flow Pressure demand .f. Addresn of manufacturen are found in lhe followlnlacction. ~.. ,,~........-~~ .. ;a.t:""..,..__..~ .... '"" """"' "' I PI! MI!OICJ(C rnn:C:!TIN NAMES AND ADDRESSES OF MANUFACTURERS AND DISTRIBUTORS American Optical Corp., Safety Products Div., 100 Canal St., Putnam, Connecticut 06260. Bullard, E.D., Co., 2680 Bridgeway, Sausalito, California 94965. Cesco Safety Products, Parmalee Industries, Inc., P.O. Box 1237, Kansas City, Missouri 64141, Cover, H.S. Co., 107 East Alexander St., Buchanan, Mississippi 49107. Glendale Optical Co., 130 Crossways Park Drive, Woodbury, N.Y. 11797. Lear Siegler, Inc., 714 North Brookhurst St., Anaheim, California 92803. Mine Safety Appliances Co., 400 Penn Center Blvd., Pittsburgh, Penna. 19535. Pulmosan Safety Equipment Corp., 30-48 Linden Place, Flushing, N.Y. 11354. Safeline Products, P.O. Box 550, Putnam, Connecticut 06260. Scott Aviation Division of ATO, Inc., Lancaster, N.Y. 14086. SurvivAir, Division of U.S. Divers Co.; 3323 W. Warner Ave., Santa Ana, California 92702. 3M Company, 3M Center, St. Paul, Minnesota 55101. Welsh Manufacturing Co., 9 Magnolia Street, Providence, Rhode Island 02909. Willson Products Div., ESB Inc., P.O. Box 622, Reading, Pennsylvania 19603. In the U.K. the following respirators have been approved for "Se in atmospheres containing asbestos fibers. The list is reproduced from the Asbestos Research Council Control and Safety GuideNo. I. Please note that the protection factors recommended in this list are much higher than those recommended by U.S. standards for similar respiratory devices. The U.S. has adopted a more conservative posture on protective factors as a result of a study by Edwin C. Hyatt entitled Respiratory Protection Factors, Report No. LA6084-MS. I~ this study the protection factors were calculated on the 36 "T1 3: CJ) 0en cc0oo A~"'O-JQO flr""l'tW'M1--r-.-- basis of average penetration of DOP obtained from test ~ubjicts during five basic exercises designed to simulate a wearer's head and facial movements during actual working conditions. PART I Respirators approved for use in asbestos concentrations up to 40 fibers per milliliter (4 fibersfml for crocidolite). These respirators may substitute A or B in Table II. 1. Duralair dust respirato-r, fitted with Type R 1100 dust filter Safety International British American Optical Co. Ltd. Radlett Road Watford, Herts, WD2 4U England 2. Filtasafe single cartridge dust respirator, fitted with FCt fine dust lilter Siebe Gorman &. Co. Ltd. Oa\is Road Chessington Surrey KT9 ITW England 3. Filtasafe twin cartridge dust respirator, fitted with type FC1 or FC2 line dust filter - Siebe Gorman &. Co. Ltd. Davis Road Chessington Surrey KT9 ITW England 'il 4. Baxter Filtrex dust respirator, fitted with an encapsulate< filter The Leyland &. Birmingham Rubbe~ Co. Ltd. Leyland, Nr. Preston Lancashire, PRS IUB England 5. Baxter Pneuseal dust respirator, fitted with an encapsulate; filter The Leyland &. Birmingham Rubber Co. Ltd. Leyland, Nr. Preston Lancashire, PRS IUB England THE MEDICAL BULLETIN 6. Martindale Type T dust respirator Martindale Protection Ltd. Neasden Lane London NWIO IRN England 7. Martindale Type U dust respirator Martindale Protection Ltd. Ncasden Lane London NWIO lRN England 8. Martindale Type W dust respirator fitted with an encapsulated "Ultron" Type B dust filter Martindale Protection Ltd. Neasden Lane London NWlO IRN England 9. Martindale Type X dust respirator, fitted with an encapsulated Type B fine dust filter Martindale Protection Ltd. Neasden l.011e London NW 10 IRN England 10. Martindale Type Y dust respirator, fitted with encapsulated Type B filters, part No. 18006 Martindale Protection Ltd. Neasden Lane London NWlO IRN England 11. Safirmatic dust respirator, fitted with a yellow encapsulated dust (Type B) filter Chapman and Smith Ltd. Salir Works East Hoathlcy, Nr. Lewes Sussex, BNS 6EW England 12. Purair dust respirator, fitted with a yellow encapsulated dust (Type B) filter Chapman and Smith Ltd. Salir Works East Hoathley, Nr. Lewes Susscll, BNB 6EW England. , -3en: 0 (JI 0 U) U) ASBESTOS HANDLING PROCEDURE -- ..------- ...~ __._: 13. Protective RQ 1000 dust respirator fitted with Safeair No. 54 filter cartridge Protector sarety Products (UK) Ltd. Protector House 719 Banbury Avenue Slough Berkshire, SLI 4LL England 14. Protector RQ 2000 dust respirator fitted with Safeair No. 74 filter cartridge Protector Safety Products (UK) Ltd. Protector House 719 Banbury Avenue Slough, Berkshire, SLI 4LL England 15. Protector RQ 200 dust respirator fitted with either RC 54 or RC 74 filter cartridge Protector Safety Products (UK) Ltd. Protector House 719 Banbury Avenue Slough Berkshire, SLI 4LL England 16. Protector RQ 100 dust respirator fitted with RC 54 filter car- tridge with exhalation valve identified by the part No. X210/D Nos. 13-16 are also marketed under the name "Protectair" " Protector Safety Products (UK) Ltd. Protector House 719 Banbury Avenue Slough Berkshire, SLI 4LL England 17. Dustfoe 66 dust respirator fitted with fine dust filter, the respirator identified by gold coloring of body and marking thereon of part No. 260846 Mine Safety Appliances Co. Ltd. Quccnslie Industrial Eatatc Olasgow 033 4BT Scotland 39 THE MEDICAL BULLETIN . --"~~---~~- 18. Angus DM 662 dust respirator fitted with Angus filter car tridges type "B" Angus Fire Armour George Angus It Co. Ltd. Bentham Lancaster, LA2 7NA England 19. RP 1620 dust respirator fitted with RP 4 or RP 14 fine dust filters James North It Sons Ltd. P.O. Box 3, Hyde, Cheshire, SKI4 IRL England 20. RP 1610 dust respirator fitted with single RP 4 filter and twin exhalation valves carrying the mark SP 1022 James North It Sons Ltd. P.O. Bd'it 3, Hyde, Cheshire, SKI4 IRL England U. RP 1660 dust respirator fitted with single RP 4 filter and single exhalation valve carrying the mark SP 1022 James North It Sons Ltd. P.O. Box 3, H>de, Cheshire, SK14 IRL England Z2. Draeger Normalair dust respirator, 74/815, fitted with a fine dust filter Type DN 815 Draeger Normalair Ltd. Kitty Brewster, Blyth Northumberland, NE24 4RH England t3. Phoenix dust respirator, fitted with a yellow encapsulated dust (Type B) filter Phoenix Acc::ssories (Milnsbridge) Ltd. 77 Waterloo Road, Pudsey, Yorkshire, L~28 8DQ England !4. Staysafe dust respirator with yellow encapsulated dust (Type B) filter Staysa(e &. Co., Ltd. 909 Wolverhampton Road Warley Worcestershire, 869 9RR England , 3e-n: 0 (JI ~ 0 0 ASBESTOS HANDLING PROCEDURT-- " PART ll High efficiency respirators for use in asbestos concentrations up to 800 fibers per milliliter (80 fibersfml for crocido\ite)-(see n.ote . below). This respirator may substitute Fullface B in Table 11. 1. MSA Type 3S High Efficiency Respirator, fitted with an Oval Ultra filter cartridge Part. No. 140-0013 Mine Safety Appliances Co. Ltd. Quecnslie industrial Estate Glasgow, 033 4BT Scotland PAF.\T Ill Positive pressure powered respirators approved for use in asbestos concentrations up to 200 fibers per milliliter (20 fibersjml for crocidolite)-(see note below). This respirator may also substitute Fullface B in Table II. 1. Martindale Mark II positive pressure powered respirator (fitted with a fine dust filter) Previously listed as the Martin- dale positive pressure .powered respirator Martindale Protection Ltd. Neasden Lane London NWIO IRN England PART IV ~. High efficiency positive pressure powered respirators upon which no limits of dust concentration have been placed-(see note below). This respirator may substitute C in Table II. 1. Powermask positive pressure powered respirator Siebe Gorman It Co. Ltd. Davis Road, Chessington Surrey, KT9 ITW England NOTE: When selecting the respiratory protective equipment in parts 11, Ill and IV above, due regard should be given to the circumstances in which it will be used which may affect visibility and maneuverability, e.g., work in confined spaces and on scaffolding. 41 SUBSTITUTES FOR ASBESTOS* In view of the requirements of the recently issued Exxon asbestos control recommendations, concerning available substitutes for asbestos containing insulating materials, a survey has been made to update our lists of asbestos-free substitutes. Initially only suppliers in the U.S. and the U.K. have been surveyed. Additional surveys wil~ be made in other countries, to complete our Iiles. The list of asbestos-free products obtained from the U.S. survey eflects products currently available. The U.K. survey results reflect lroducts available as of January, 1973. This list will be updated at a ater date. Since many of the quoted products change periodically, 'oth the manufacturer and supplier should be contacted to insure hat the appropriate product is available. Complete manufacturer 1roduct literature is kept in REH D Files and detailed inquiries on pecific products will be available on request. We would like to acknowledge the assistance and efforts of J.T. ianderson, who provided information on suppliers in the U.K. nuecl September 10, 1976 by Euon Corpontion, Medical Department, Research and Environmental leahh Divilion, (J.F. Stelluto). "TT 3en:: 0 U'l ~ 0 ~ suasTITUTEs-f:oJfAn-nros Produel Compoalllon Temperature Llmll Reported By Manufacturer Manufacturer CATEGORY: PIPEIINSUL.ATION J.M Flame Sale Aarotube JM Flame Sale AP J.M Flame Sara APT Mtcro-Lok Flame Sale ML Matal-On Tamp-Mal Ins. Foam Glas HIT UNI-JAC TAB-LOK Eptherm 1200 CPR9005-2 TRY MER CPR9545 CPR9008-3 Glass Fiber Closed Call Foamad Plastic Glass Fiber Wllh Thermo Setting Resin With Pressure Sensitive Tapa Closure System Fiber Glass Metal Jacketed Fiber Glass Tharmo-12 Calcium Silicate Wllh Aluminum Pre-Jackal Glass Fiber Sealed Glass Cells Vinyl Jacketed Foam Glass ~ineral Fibers Between Steel Sheet Mineral Fibers and Binder Urethane Rig!~ Foam Urethane Rigid Foam Urethane Rigid Foam o. sooF. 220"F. o. sooF. Johns-Manville Johns-Manville Johns-Manville o. sooF. Johns-Manville Max. 650"F. 500"F. 1500"F. Johns-Manville Johns-Manville Johns-Manville Max. 1200"F. Pittsburgh Corning Max. 1200"F. Pittsburgh Corning -soF. to +450"F. Pittsburgh Corning 1400"F. Eagle-Picher 1200"F. 250"F. 300"F. 300"F. Eagle-Picher UpJohn UpJohn UpJohn CATEGORY:SPRAYABL.E Kaowool Spray Mix Alumlna-Slllca Deck-shield CF Mineral llbarsand Blndi; H"eat Shield Mineral Fibers and Binder Power Shield C/F Non-Crystalline Flelraetory Fibers ISONATE CPR425 TRVMERCPR421 ISONATE CPR485 Urethane Foam Urethane Foam Uralhana Foam 2300"F. 1400F. +225"F. +300"F. +225"F. Babcock & WilCOX CAFCOIUSM CAFCOIUSM CAFCOIUSM UpJohn UpJohn UpJoM In the U.K. Caramospray In s u r , at Cescada Service Co[ Glottar Saro Co. ,. Spray Mondoval Ltd. "Mandax 04 Vermiculite" Need respiratory and eye protacUon when apptylf19 or stripping. CATEGORY: INSULATING AND FINISHING CEMENTS No. 375 Cement Hydraulic Setting 1BOO"F. No. 480 Cement Mineral Fiber 1800"F. MW One Mineral Wool Base 1000"F. MW 50 Mineral Wool Base 1800"F. Johns-Manville Johns-Manville Celotax Calotax l43 t _............~~~- ~: ~ lilt; Ht.LJil.t\1.- UUI.Lii liN Product Compoelllon Temperature Limit Reporled By Manufactvrer Manuftclurer CATEGORY: INSULATING AND FINISHING CEMENTS (Cont'd.) Fibrous Adhesive Super190 Hllcolt Flnlahlng Cement Fibers. Silicate of Soda and Flllare Mineral Wool and Clay Mineral Wool 800"F. 1900"F. 1200"F. No. 1 Insulating Cement Mineral Wool 1700"F. 2 Super ""68" Ina. Cement Mineral Fiber 1700'F. One-Cote Cement Bond Seal (Spray) Comlnco Cement Mineral Fiber with Filler~ Mineral Flbere and Cementltloua Binder 1200'F. Ceramic Adhesive RefraC1ory Flbert end Binder 3200'F. Celotex Keene Corp. Babcock & Wilcox Babcock 6 Wilcox Eagle-Picher Eagle-Picher CAFCO/USM CAFCO/USM Cotronk:a In lht U.K. "! Plaatlc Compoalllona "Potrlte 8 G" used up to 593'C. (1100'F) Pottere lnauletlone Ltd. "Potrlte 3G Printing" used up to 593'C. (110Q'F). Pottare Insulation Ltd. uMagnasla 68" used up to 318'C. (800'F). Chemical & Insulating Co. Ltd. Hard Setting Compoeltlona Cape lnaulatlons Co. Ltd. Wm. Kenyon 6 Sons Ltd. Potters lnsuleUon Ltd. lti~Stttlng Compoalllona (bated on cementa) Newalls Insulation Co. Ltd. Cape Insulation Ltd. Chemical & Insulating Co. Ltd. JoMph Nadln Ltd. Potters Insulation Ltd. CATEGORY: BLANKET-FLEXIBLE Mlcrollte and R Serl11 Fiber Glasa With Thermo- Mic:rollte selling Resin Hllblankat Mll)eral Fiber Blanket Silica Based Mineral Wool Mineral Fiber With - Kaowool Blanket Metal Fabric !(aoun Kaowoot 2600 Alumina Silica Fireclay Ceramic Fire Blanket Refractory Flbera 250'F. Faced 350'F. Unlaced 0 900'F. 0 1200'F. 1400"F. 2300"F. 2600'F. Mu. 3200'F. In tht U.K. Mattrttatt, Blankett & Rolla (Mineral Wool) "Rockel! Mineral Wool" ulad to 593"C. (1100'F.) "Eidonltt Mineral Wool" Cork Insulation & Aabaetoa Co. Ltd. "SUIIIte Mlnerel Wool" Stllllte Products Co. Ltd. "1100 B/S" 11-bsltt. used up to 1250'F. Union lneulatlon Co. Ltd. Johns-Manville Johns-Manville Babcock & Wilcox Babcock & Wilcox Eagle-Picher Babcock 6 Wilcox Babcock & Wilcox Cotronlca 44 "T1 e3n: c0.n ...a. 0 N SU'DSIIIUIES FUR ASUESI~- Product Compoelllon Temperature Limit Reported By Manufcturer Manutnturer CATEGORY: RIGID BOARD MarlnlteXL Calcium Silicate and Inert fillers DU-ALL Semi-Algid Fiber Glau 800 Sarles Spln-Gias Llnacousllc A Plenum Algid Fiber glasa Fiber Glass Liner Tank Top Insulation Mineral Composition Board Hllboard Superglas Board MTBoai'ds Silica Based Mineral Wool Flbera -Mineral Fibers Mineral Fiber& M Board Alumina Stllca Flrtclay Kaowool 3000 Alumina Flbert Cellofoam Polystyrene Ceramic Board RelraC1ory Flbera Johns-Manville sooF. 250'F. Johns-Manville Johna-Manvtllt Johns-Manville 250'F. 1200'F. 1800"F. 1050"F. 2000 3200'F. 1000'F. 75'C. 3200"F. Johne-Manvtlle Babcock &WilCOX' Eagle-Picher Eagle Plcl'ler Babcock & Wilcox Babcock & YIUCOXi CAFCO/USM Cotronlca CATEGORY: PAPER Paper Alumina Silica Fireclay Ceramic Paper Refractory Flbera 2000. 3000'F. Babcock & WliCOll: Max. 3200"F. Cotronlca CATEGORY: PIPE SECTIONS TUBULAR ROUND Mlcro-Aire Algid Round Fiber Glass Preformed CATEGORY: PIPE SECTIONS FLEXIBLE ROUND Mtcro-Aire Fix Fiber Glasa Max. 250'F. Max.250'F. Johnt-Manvlllt Johna-Manvllle CATEGORY: PIPE SECTIONS RIGID ROUND Transite Air Duel . Mineral Flber.Cement CATEGORY: BLOCK H.T. Banroc Mineral Fiber Wllh Clay Binder Glasrock Foam 50 & 30 Fused Silica Foam Hllblok Silica Bated Mineral Fibers "PV" Supertemp Block Mineral Fibers Bonded Epltherm 1200 Mineral Flbera Bonded CeramiC Fiber Block Aluminum Silicate Flbert Kaowool Block Kaolin Block lnaul~llon Gla11 Fiber Mineral Wool Max. 1800'F. Johna-Manvllle Max. 2000'F. Glaarock Product 19()(1'F. BabcOCk & Wileo1 1900"F. 1200'F. 2300'F. 2300'F. Max. 1800'F. Eagle-Picher Eagle-Picher Eagle-Picher Babcock & WIICOJ Babcock & WIICOJ In the U.K. "Potrlte Calcium Silicate" Poltert Insulation Ltd. "Calcium Silicate" Joseph Nadll Ltd. "Calcium Silicate" Chemical & Insulating Co. Ltd. All the above may be used at temperatures up to 593'C. (1100"F.) "f.S. 1100 B/S" 11-lbs/H.' used up to 1250"F. Union Insulation Co. "Fiberoc HD" 12-lbalft. used up to 1350'F. Union Insulation Co. "Rockall 144 HD" 9 -lbalft.' used up to 1247'F. Cape lnaulatlon Co. "LA. 144" 9 -lbl./11.' uaad up to 1247'F. Cape lnaulatlon Co. "SIItlltt Mineral Wool (StlleakiJ" 10. lbtlft. uted up to 1382"F. SIIUite Producta Lid. ~ lI l j'" ". "L r il.l Procfuct Compoeltlon Temparalure Limit Reported Sf Manufacturer Manufacturer CATEGORY: FLEXIBLE SHEET Aerotube Cloead Cell Foamed Plaetlc Sheet Flex White Silica Bua Mineral Wool Superglaa Felt Mineral Fibers Supetglu Moldable Felt Inorganic Fibers Wet Felt Alumina Slllc11 Fireclay Max. 220"F. 1200'F. 1800"F. 1800'F. 2300'F. Johns-Manville Babcock & Wilcox Eagle-Picher Eagle-Picher Babcock & Wilcox CATEGORY: PIPE FITTINGS INSULATION Zeston PYC Covered Fiber Giese o- sooF. Johns-Manville CATEGORY: DUCT INSULATION FLEX AND NON-FLEXIBLE Mlcro.Aire M/F Fiber Glass Max. 250"F. Therm-Lock Closure System Aluminum Backed Solid Polymer Max.170"F. Flex-Met Aluminum 100"F to ~DO' F. Unacousttc Fiber Glau Max. 250'F. 800 Sarles Spln-Giaaa Fiber Glass With Thermo aettlng Resin 350"F. Unlaced 250"F. Faced Johns-Manville Johns-Manvllla Johns-Manville Johns-Manville Johns-Manville CATEGORY: REFLECTIVE INSULATION METALLIC J-MRefl~lve Stainless Steel or AlumiJl.um 750'F. JM Encapsulated Stainless Staat, Aluminum tnconel or Titanium Up to 2200"F. J-M Thermo 12 Calcium Silicate and Aluminum Up to 1500'F. Johns-Manville Johna-Manvllte Johns-Manville CATEGORY: INSULATED PANEL Metal On Spin Glan lnaulallon With Aluminum Sheets .C50'F. Johna-Manvllla CATEGORY: SURFACE COATINGS :>tttc:ote300 Glass Fabric Reinforced Mastic Plttcote .coo Ylnyl AcryliC Plttcote 800 Asphaltic Pittcote 807AL Kaowool Cament Aluminum Pigmented Asphaltic Ceramic Fiber AluminaSilica 200'F. uoF. 250'F. 250'F. 1600'F. Pllttbur.,h Corning Pittsburgh Corning Pittsburgh Corning Pittsburgh Corning Babcock & Wilcox CATEGORY: BLANKET AND BOARD ~ 1000 Series Spin-Glass High Temperature Felted Spun Glass Fiber Max. 850"F. Johns-Manville CATEGORY: LOOSEBULK 9ulk Wool Sandstone and Blast Furnace Slag Melted Together Kaowool Bulk Kaolin 2300"F. 2300"F. Babcock & Wilcox Babcock & Wilcox In the UK. Fiber (flock filling for mattresses) Turner Bros. Ltd. Flbreglus Ltd. 46 Product Compotltlon ... Temperatura Limit Reported Bt Manufacturer Manutactum ? :"Ts1: ~ -e0n 0w - - _4_ _ _ _ _ CATEGORY: EXPANSION JOINT AND SEAL INSULATION Pitt Seal111 40F.to + 180"F. Pittsburgh Corning Pill Seal222 -20"F.to + 180"F. Pittsburgh Comtno In the U.K. packing Scandura Ltd. "BBA Glue Rope" Morganlte Ceramic Flbrae Ltd. "Triton Kaowool" Carborundum Ltd. "flbralax" Darlington lnsulatlo:~ Co. "Ralraall" Johns-Manville "Ceralell" CATEGORY: ROPE AND WRAPPING CCM and CGM Cordi Carbon and Graphite ACM and RGM Ribbon Carbon and Graphite TCM and TGM Cloth Carbon and Graphite RYC And RVG Falla Fabri-Therm Ill Silicone Treated Glasa Clolh and Tape 76599 76511A Gem at Composites Carbon and Graphite Varnished Glass Cloth and tape Silicone Resin Coated Glass Cloth Glass Web/Polyester Film Laminate Gemat Rope 78520 Fusa-Fab Glass Yarn Cloth coated With Polyester Kaowool Strip Kaolin aoooc. 3000"C. 3000"C. aoooc. Max.180'C. The Carbona COtfJ. The Carbone Corp. The Carbone Cof1), Tho Carbona Corp. General Electric Mu. 180"C. Max.180"C. 180'C. Mu. 1aoc. 150'C. 23ooF. General Electric General Electric General El~rlo Generel ElectriC General ElectriC BabCOCk l WIICOII In the U.K. Cloth (Giaae) Mattress-making. temporary lagging. expansion jolnta, bellowt pieces and applications requiring naxtblllty. Scandura Ltd. Fothergill & HaNey Ltd. Turner Bros. Ltd. Tape Scandura Ltd. - ''BBA Glass Tapa" various wldthl. etc. Turner Turner Bros. Bros. Ltd. Ltd. "Glass Webbing" FORTEX Asbestos Textile, man~tlactured from liquid dispersed asbestoa.j Has minimal dust hazard In handling. Acceptable where glass cloth or! ceramic llber Is not practicable. Yarn -Thread Turner Bros. Ltd. Fotnerglll & Harvey Ltd. CATEGORY: JACKETING Jaxsan 800 Tnermoeattlng Polymer Hydrocal B-11 Ultracal 30 Denslte Gypsum Gypsum Gypsum .. 220' =. 500"1'. 500"f. sooF. Plastic Coatings ~ U.S. Gypsum~ U.S. Gypsum Co~ U.S. GyP.Sunl Co~ 4~ Ir~.' THE MEDICAL BULLETIN Produc:t Compoelllon CATEGORY: JACKETING (Cont'd.) Plnwrap Asphalllmpregnated Glass Fabric With Aluminum Weatherproofing Jacketa Asphalt Saturated Mineral Fiber CATEGORY: PIPE AND BLOCK Thermo-12 Hydrous Calcium Silicate Celo Temp.1500 Expanded Perlite Carey Temp. Elbow Ina. Expanded Perlite Temperature Limit Reported By Menufacturar Manulaclurer Mu. 35oF. Plastic Coatings Inc. 2soF. Johns-Manville Max. 1500"F. 1500F. tsooF. Johna-Manvllla Celotex Celotex Suppliers In the United States Eagle-Picher Industries Inc. Chemicals and Fibers Division P.O. Box 779 Cincinnati, Ohio 45201 General Electric Chemical and Metallurgical Division Schenectady, New York 12306 Pittsburgh Corning Mechanical Systems Insulation 800 Presque Isle Drive Pittsburgh, Pennsylvania 15239 Babcock & Wilcox Refractories Divison Augusta, Georgia 30903 Johns-Manville Insulation Center P.O. Box-5108 Denver, Colorado 80217 Keene Corporation Insulation Division P.O. Bo~ 145 Princeton, New Jersey 08540 UpJohn CPR Division 555 Alaska Avenue Torrance, California 90503 The Celotex Corporation P.O. Box 22602 Tampa, Florida 33622 The Carbone Corporation 400 Myrtle Avenue Boonton, New Jersey 07005 Glasrock Products, Inc. Fused Silica Division 2210 Marietta Boulevard, N.W. Atlanta, Georgia 30318 Cotronics Corporation 37 West 39th Street New York, New York 10018 CAFCO USM Products Co. Stanhope, New Jersey 07874 48 "T1 3: ~ 0 (J'I .....a. 0 ~ ... ---~- -----------~~-- SUBSTITUTES FOR ASBESTOS I> <" :> Suppliers In the United Kingdom Mandoval Ltd. Potters Insulations Ltd. Chemical & Insulating Co. Ltd. Cape Insulation Co.. Ltd. Wm. Kenyon & Sons Ltd. Newalls Insulation Co. Ltd. Joseph Nadin Ltd. Cork Insulation & Asbestos Co. Ltd. Union Insulation Co.Ltd. Scandura Ltd. Morganite Ceramic Fibres Ltd. Carborundum Ltd. Darlington Insulation Co. Johns-Manville Fothergill & Harvey Ltd. Turner Bros. Ltd. Stillitc Products Co. Ltd. ...,.. ~ ~ I ~