Document 2Nvq7DE8NZD4Jo80D3EGgZaz5

FILE NAME: Metropolitan Life (ML) DATE: 1931-1935 DOC#: ML305 DOCUMENT DESCRIPTION: Dr. Lanza Article Edited by Johns-Manville o I  . . 70KS7CBD th e authors wish to express th e ir sinners to a l l t i e s who aid ed In eahlTig th i s stu d y p o s s ib le , e e p e e ia ily th e o f f i c i a l s and eeploVees o th a a sb e s to s corpani.es who co o p era ted to th e f u l l e s t e x te n t and g ara e r e r y f a s i l i t 7 fo r securing d a ta . Also to U r. Tancoast o f th a U h ire rsity o f H em syl T ania f o r h is i n t e r e s t and r al aabl a a d r ic e La in t e r p r e t i n g Z -ru y f i l n s and to Dr. 7 . T. M eriwether, U nited S tates T ablio H ealth S e rris e , Surgeon in Charge of tha U nited S tates 3 u r!aa of Hinas CocperatiTO C linia in H iahar, G hlahsca, whose in t e r p r e ta tio n o f a l l th a Z -ra y f i l n s l i s t e d in t h i s re p o rt i s fo llo w e d . Also to Dr. . A tnar S a ith , and Dr. Henneth Lynch o f C h arlesto n , S.C. fo r in fo m atio n end ad rice, p a rtic u la rly as to the pathology o f asb esto eis;* to D r. . . il d o f C h a rle sto n , S .C .; to D r. Jo sep h H. y a tt o f Heuurh,. H .7 ., and D r. H. H. 7 sllo w s o f Haw T crh , f o r a s s i s t i n g in i n t e r p r e ti n g Z -ra y f i l n s ; to Dr ? a u i 0 . Scohs o f L a n c a s te r, 7 a . ; to D r. 2 . H. S taren so n o f D a n r illa , Quebec, Canada; to Dr. 1 . U. G ardner and Hr. Donald 3 . C tnsinga o f Saranac L ab o rato ry , who h are n n dortahan th e stu d y o f th s p a th o lc g ita l e f f e c ts o f th a in h alatio n of asbestos dnst through a n ira i experiuentation, w ith the aid of a grant iron the M etropolitan. L ife Insurance Caspany. * *A sbastaals 3odies in Sputua and lu n g , Henneth II. Lynch, JI.D. and . A tn ar S aith , H.D., C harleston, S .C ., Jo u rn al o f Anarican Medical A ssociation, August 30, 1930, V ol. 95, Ho. 9, pp. 659-661. ( t 3 oi :3 Oi 3 3 m7 8 J I FEJMT A Dept. Ho. Ganplea Taken Preparation 6 Card roon S Ring frano e i aplnnlr.g roon 1 Uula apinning e T cla tln g 10 U lllion to w n por c u .f t / of .dr J to l i to 1 2/5 i to ^ 2/5 to Z \ 1/5 to l j PLANT B i. i*' . . ; */. Ito. Qaspies Taken U lllion P a rti les por cu .f t . of air 0 i to 8 5 i to 4 \ -- -- 6 1/5 to 1 Included In spinning Reaving A F elt Dept. 6 Sheat In a sulating MaId od hraku hand and clutch o i'<n 1/20 to 2, 4 1 /3 to 4 4 If -- 1 / 6 to 4 -- l 1/5 to 4/5 -- -- PT,AHI' 0 c ,,' >i >. ' ' *-w * Ha. Sanplao Takan U L llian P a r ta la s per cu .f t . or nlr PUHT D .* ** . PUHT E Ho. ' Hanplofl Taken M illion P a rti la s per c u .ft. of ir Ilo. 3oopioa Taken M illion P a r ti la s por c u .f t . o f air 0 to 43 -- 8 80 to 02 6 to 15^ -- -- 8 6 to 78 -- -- -- -- -- 1 8 to 4^ -- 9 1 to bJ . (in oltri os brooii loan wanviii) . 6 B to 10 18 -- -- -- --. . --T -- 1 ,, . -- 8 8 i 1 to 7 8 -- -- -- -- $ to 8/S 6} to 10 8 1 /3 to 7- j (In a l trios j brood lo o , j weaving) 1j --------------- lOj to 19j ! -- ------------. . . . . -- f m U * art J A * I aoi also ia w eav.ing d. o p u rtn e n t whero **'--a '.cc-Lau--t'T.Oo h**u n iud ityJ was 75 ? r c e n t, c i t h a. d ry b u lb te c p c r a tu r a o f Mf AUrN? . , ,,asN NcNeN-M, aNN. A. afl ^* 1 *--2? Aa r -- kMnT9 hluNN^N *J 0 44 p e r c a n t. l a th a weaving ro c s o f j l a s t k . . Aaida ir o n p l a n t 2 , which was u n n e c e s s a rily * 7 ^ *o a l i a750sir t h a t th e d u s t h a z a rd was =0*. e x ce ssiv e esca?*, l a th e p r e p a r a tio n rocca o f j l a c t a 3 * -d C. The d u s t co u n ts a ra in t e r e s tin g -3<3i rh o a M i d e r e d in th a l i s h t o f th a p e r u is s ib l e s ta n d a rd f o r s ilic e o u s dea*., . ta b lis h e d by th a U n ited S ta ta a P u b lic H ealth S e rv ic e , nsuely 10 c iU ic c p a r tic le s (10 cicrona and nndar) p a r cubic f o o t, However, ira a ra n o t J u s t i f i e d in a s s u rin g th a t bocanaa aabeaocaia Ls- a n i l d a r d is e a s e , 1, . ' < s i l i c o s i s , th a th rs a h o ld o f p e r u is s ib le d u st counts is h ig h sr. A sbaatasis ls p ath o lo g ically d iffe re n t := s i l i :o s is , a r i th a ex p erien ce so f a r does n o t w arrant &n a t t a e j t to d a fin a en a r b i t r a r y # pgs? coiraos Various caesu ras, such as o ilin g , h u n id ific a tio n , id lo c a l exhausts, tended to reduce th e d u s t. N e v e rth e le ss, i t was e v id e n t th a t th e y ware cnl7 p a r tia lly su ccessfu l. I t also is apparent th a t, i f i t is expected to control d ustiness in these p la n ts , f in a l reliance a is t re s t upon properly constructed ,, t o * aq u ip u eu t. lu p la n t C in one d .p a r tn e a t an e x p e r in e n ta l i n s t a l l a t i o n was s a t up. In s p ite o f sene obvious f a u l t s , t h i s e^ u ip n an t,' on th e b a s is o f ccx p a ru tiv e d u st c o u n ts, reduced the d u st by 50 p e r c e n t, and w ith f u r th e r a lte ra tio n s w ill probably be 75 p a r cent, e ffe c tiv e . J o r a l l p r a c tic a l purposes th is is yiita s a tis fa c to ry . I t is n e ith e r p ra c tic a b le nor econcnicaiiy d eo irab le to I n s ta l l such e^uipcer.t as w ill nshs the a i r e n tir e ly dust fre e , eve- -- s I* -H ealth o f w erhcrc in r u s ty Trades (G ranito Ind: I So. 137, G.S. ru b ile H ealth Servico, Washington, 13 C C a s : s * s ^ vs W -- 1 * te ` #% M t.tee am m9 n i 3 &a X U7 te vt 3 te "7 2a aa* a a 1 aa X X r** l X a taa r- i 1 A? 29 9 m * ? aa a %a#a M MM tNl t#e w* % M te *4 MM n WW ^* - ta aa T 9 Jr t aVa ai a ? a a a aaa J ! s J a * i a i i ! ate aa r i I* s r <* I s 3te m I i aa 5 1 * a a ri! J ci 4a 3 raa X * a ai aa i si r s X r ? te 2 1i I j T 5 9r% fi r 3 a S - i X X . 3 I X i c; ! ! I ;! m I~ i * i N s 1te * J a * r s ; a J7 7r li t i :. "E r* .a ? r 2 r I =s ; t I - U - r a a y a ta a a a *m a Ia* a 3 J9 .P * * a te aa a 9 -- a 3" a y aa T 5* a 3 o a <a* 3 Sa i 9 TaT. J* 9 am a 3 aa 4aa taeiaa a T a a a te i 1I4 1V4 aaay4 ay* a te a I a 33 3 y i Xy y I- a * Z aa * 3 aa X a 3 3 1 an a"* a aa 9 a 1 : Ii a9 T 5 a it na tae ay aa a a. r ri taae aa a a 3 t a te * > - ** * a a i u Vi a*y tre aa aa a Z5. te a a ..3 53^ aa te 2 19t aa a a1 * 9 a - a. a. tMe 9 ay a* Mi w* r i wa m aa $ te a 9 i 4* n faa a y aa na I Uy "T y 4 na. aa a T te * t - a ate i 3 B 9 X a 1 M a * 9 y W aa a S3 3 3 w33a 9 3 aa aa >a a teV a m w9ryT 9y i tete tae 9 te a r :** 3T 15 a9 Ste3a aa 3 i i .i 4i* sj*=3: i * b m <2 - % - -A if n 3 M a Va a - - V 7 7 f T 1 r r i j- m a J <? I ! X X r i : s i (M r>, r a .3J u i :r 1s ^ ! r = ,? 4 te7 !a : I 7 wtetJe SI mn aa* l ante r 41 a 12 s. i? y a L ter 22 a JaC * rt te - y am 9 9 aC S- te a*9 S3 3 3te a9 i 7 33 7 i i i 9 te- y a a i a a 4a a aa aa a ntre iy My mte a9 a te a a a te 4y i 5 a a -- ra *r t/e 9 a Ma aaa * a 3 2a a .* ** .a i a a >* r _ I * a7ij I l"'" i il 1 CrlL>l 1* 1 ^ \t i I 1% \ r ^ . i i ' r I * I1-' X r \ T L L -- `*"m* ........................ ' r. , -- *-- *' li.t ' t r t V.VK >- , \ m_ , I " , lU r I V . * l" ' ,\ l f . ,, . ,, . I t l l - t ** i !|l u 1 V*-- ' . . T,-*-- ** ,Mt 9 i1 \I `*"" . ....... ,.U. .lU. u*i ifn''"* * 1*1*'" " ** " '" l'"tv K L U .* * - **u,` ' 1 \ .ut. v,,`" 1 ..r.,,,>.Ui 'M' l\ t * " *" ' 1* * " . w V , *- I ir-.**-- *"*1 \ \ , L U -* -- \ I ...... V.1 'll 1 Jll1- ' .4, M ............. Mu. t l ... I.llt"''- U i-.-- r " \. ..s. i'-*"' , vH - U - - i,,,\ i L-c l'1" ........... 1. ImV\ I-t*Hull M,l*r' 1 1 l *" ,...... U - ' - " .......... .i --`* .... \ s s s a . t s a 5 S S : J r ..... .i... -* ............. ** . I| 1'" .,,y -- >............. * .>..L \i1*.l-. . . , .....................,._.._..._-..._.._.._.".*..,- .......... `V \ t,,. * 1 U. ,i .vi. Mu. t**' *'* \ ...... * MU*-' **".......*....... ..... .. ,, J.UK. Vf- "`*" *'* Mijiuv***.^*T'**^**r .1 - " 1 .......................................... . 1............. U 17 48 ' ,1 ' 1 w t s: u s *1 ? If ? V u ! 1 i AAA m t TTMM7Tl lifXTxy - 14 - Ovar 13 7 *ats 10 to 13 7cxs 5 to 10 7 ars Cedar 3 7 sars Total znined TA3I3 n Tears of Ssuosura p e sitira 13 7 30 * 17 47 Doubtful ScgntlTa Kpeirt tie s) 3 3 2 27 3 11 ' 12 39 ' 20 (1 eat eon- tin uous) it , b u t, I l l s the tiro pravioua, e ra o f l i f t e d ra lu a and l i t t l e i s the **7 of d s f i n i t a ccn elu sices 3 be t e d upon. th a n . 50 and over 40 to 49 30 to 39 20 to 29 Cedar 20 704 to ta l azaeiesd TA3IZ 711 Age Groups itiT S 1213 17 24 1 47 D o u b tfu l 3 4 12 14 2 39 Sega,t i r a 2 4 4 8 0 20 Cala (to ta l in d eed 108) Sacala ( " ` .13) P o s iti v e Doub-I 1 to 2 inches 2 to 3 inches 3 inches pies Sot ceceir.cd Total p o s itiv e 23 31 3 3 07 D oubtful 13 21 3 2 39 S e g a tiv e 7 12 0 20 1 n i ; S `- Death c la in s : 1. Proved to bo a t 7? i s t , so t xpocod to dust; died of puinonnry end in te s tin a l tu h e rc u lesis. 2 . Colored male age 27; worked in asb esto s e u y e a r and eight e o a th s ; d ie d o f puinonnry tu b e rc u lo s is fo llo w in g * . hem orrhage; was i s sanatorium t a s o u th s . Also had a fo u r ' p is s C asserao n . Ho rider.ee o f a s b e a to s is . 3. C olored sale- age 32; worked in a sb esto s p la n t one y e a r and se re u so u th s;' d ie d of puinonary tu b e rc u lo a is a f ta r cue south * i s h o s p i t a l . C a v ita tio n b o th lu n g e ; no e rid e n ce o f asbes~ toads. - 4 . C olored s a l e age 3d; worked in ao b eato s p la n t two y e a rs , and s i s s o u th s . E ia p h y s ic ia n b e lie v e s t h i s was a ease o f uneo sp lleated tu b e rsu ie c is. Tia not innate o f h o sp ita l or ' sanatorium . So ro m a tio n could bo o b ta in e d c f a o th e r two cases except fren the death c e r t if ! as rh ich gave pulsar:ary tu b e rc u lo sis as the cause of death. to ta l and pam anent d is a b ility cl: 1. Xala, espleyed in asbestos p la n t three years. Eis physician s ta te s ha f i r s t cans under h is observation w ith an old e s ta b lis h e d ease o f tu b e rc u lo s is about two y e a rs a f t e r asbestos, employment s ta r te d . Also had tu b e rc u lo sis o f the kidney and c e rv ic a l glands. 2 . h a le , employed in asb esto s p la n t e ig h t so u th s, S is physician. sta te s old fib ro id tuberculosis with tubercle b a c illi in sp u tu n . Eo 2 - r a y a v a ila b le , b u t according to p h y sic ia n asbestos bodies were found in sputun. - 3 . lia le , te n y e a rs employment. Two p h y sic ia n s who tr e a te d bi-t a t d i f f e r e n t tin e s ore now in c lin e d to b e lie v e th i s nan , Is not tuberculous, but has asb esto sis. 4,1 S h ite u u ie , was ra-ex an in ed a t t i r o o f In v e s tig a tio n . Sic p h y sician re p o rts w ell nourished, husky looking, good co lo r, no c y a n o s is ; no clu bbing o f f i n g e r : , d in in is h e d expansion, in c o c ta n t cough; 2 -ra y shews fin e n e t t l i n g d is a e n is a te d through b o th lu n g s . So evidence o f tu b e rc u lo s is . Probably a second stage asb esto sis. co tiOl.v-'riV. uui UUUI l oi i>t5lVICOS aiu 0i ! 57 r" .. >' ~t o<cr (J ! e) Decsober 1 0 , 1931 Dr k# A X T<i n ^ 3&dLecn ila tro p o l i ta n LLfa 1 iTurcxa, Sera l o r x C ity . Issuranca Co-, Rat P n lir lr L a iy Study o f t _ a . _ - t\ . -- ^ * pr Or. Lm snt . . - I baro m a i ned tha g a lley P ^ ' o i 7 = ^ " d Dr- XcCotmall p n lin in a r y fltady T^a^a Tnh.intAHt o f lo b eo to a Duat co. tha Lunga o i r ^ 3 J L _ td ch 70U fa r good nough to send. a w ith jocr- lo t~ r ber 7t h T a i haTTmrpnr^d i t w ith tha trinco em pksd peaphlet o f Tbich i t pccrporta to bo ccxider.ira .tlc a - C on firrin g ET talopbcna c o u ren n itica o f tria a ft r a n c a , I aa pi ara la to t g m ^ t tb a pr^ f ri a ta Enbart so tha ha r i d i r*e*dT thaa- tcaorroi m d jJ J ' th-4. v , r e te r th to a s c o t - la t e r tnta "Sniraday ri^ 1 -s c c a - a a a ta , a it a r rirLch I s h a ll 8 th a t th ey aro p ron p W -- f g -- ''d to c L I 8h.11 a l in e r ir * o f th a Bagrbagto Ccnpany t s ^ r or thay d a a lre to am rin tho proof o f tha art*c-.a b ^ o r * U r J T j ^ S i n g and s t a l i andsaror to persuada th ea do to I n s ia t upon Buah. a a eccarinaticn- ' 1 baia tho fo llo rin g to 3LaJcO* (1) C rtamcluezadcnapSpoe-ar1ing(:g ianl l at hr aU^ o) r itgaisn a l a a o d lf io d b7 r e o , rs a d aa fo l* c 8 t C1-. --c3-- J fre s i t h l a trtudy i - ap p aarsd to bo o f a. t7T* ^ rid d a r thaa sLlisosis* * * (=> p__a_g_e_ 15la oaf lstoh ac ao irtitgeidn atib Irsrfpi cr rstt i bp ai mehg rraepn hd a =aaa folio* rQorliLg **"" pr g ra n o o f th a trtudyr pt^"3--c s a .h o T aro r r s c t i c l n g I n th a c o m u n i t l a a n . n a ab oa i ^ a j r a r t esrna un-- l i r e d , a e r e ^ u c o tte n e v i, sud a t a t a d t h a t _ e y -- d -- __ usuai o f tu b rrrn lo o d a =*=S u trust oa r i t h brtTeaa. t h i a s t a t a o f a f f a i r s and t h a t f e u r d In = ~ = ------- ( r v,' < * ? .V - J t''I ? c cr c a ailL coeia hazard, ia noteworthy* Both the forego la g obtrerraticaa Included la tout m original report presented an aspect of 70or rurm/ that *ma ^fa-rorablo to tha Industry and aa should like to sou thca ro ta* O ) Csa g a lle y 14 th o ward "d eath * h a a boon ocsittod oftaor th a p h raea *6 o f 36" (>0 C onclutrica fo. 3 ( g a lle y 11) . Tha r o rd " o r a U r in a r y " ia in se rte d -- to ry rin d urraca." e e rily -- since tha e n tira a r tic le is d e fin ite ly la b e lle d a t tha ccn- ' acacoaeat as * " p re lirin s ry " study* (5) E aferring to tha la s t centenes o f tha third P'Xr2jtyJT^p& on. pjLgo 11 (rtdch La n ot changed ia tho g a lley p ro o f), i t cocaa to 3 th at soao so rt o f additio n a l phraea c r d a n ce i s required la order to r e la ta i t properly to , That has gene b efa ra , la i t stands rcey i t i s r a t e n tir e ly d e a r ju st sh at oas ia expected to daduco th sr a fr ca * 7ery truly 73sT . CCj lossru-Cocrg S* Hebert ZJLm Vcaarhsaa S*mL* I llliz o s a 7endiTwr B ro ra A ttera ey C JU X. \ 0 1 7- - -- u- * 9 ( 90vC/A'0*"e*3Ce,Miiuo At/** t.COO^tM aOw *O-*u*9V*.<On AC rwr.C CTU f *# 3. aOO'SCn HOfiAUf I i O I J A J R T X M i x .v r d t-srcou B i auiuoiNO I1IC3 n . \ X U X D B O C I Z V a R D BTWAII Ki.XCWJERSEY ~ *CT 1<* 1*4%. t ; Znc. 1 3 , 1C34. Ho p r o l i n d r a r y s t u d y o f a t r r p o l i t o a l i f e l a ru rr_nco Crapony 'ir. T and 7 o r B rea n , \ t t e 7 7 -7 7 , J e h r a - L b u :? i l l a n 7 . -JCtb . . t r a c t , ***w f' *f n 4 * 444 mJ S o r p e r a ti s: . c a r ITr. Iirc-xn c I rrcai-od 7 cur l a t t e r o f D occcbar 13th w ith anelo curo a , *3cL:;diaj? p ro o f o f tho erroiirtnary stu d y e n t i t l e d . ' H ffs c ta o f the VI n3- -hrau lcast ir omi 'r of lly Asti jto o Tost Tain od t h a on th o L m tps o f la b e e t o a p r o o f and r e t u r n sszco. Jorhars** I tha auro tho 7 e tr (To r c m 4*< t h e t l a r e a d i n g t h i s p r o o f I h a r e eorraa: id I t u i t h t h e p a p e r of. Tp-lch 763 p r o p o r s i by th o la d s s t r i a l H ealth 1 e r r c e o f tan a h m t th r a o yocura a ^ o . I ru b e tit tho folls-aini? one `*a o ^ of * v m c r n c I h a t o narsb-artd t r c f a l pnjpoo e f t h r c :c m eu t a ru efr)i ia rt-d p <23c (1) Cal n . A4 t h a end o f t h o pe .V^* w7Ktt**<-UM d i a r r e s c o icc-so l a i a f l u e n c <rd, :o a a e t r t cd t h a t 3 *-- 02T2* * f e u r - c ' i * '-* he r u a a c n a b l a " o bn. hi l i t ; 3 s e id o n r a t and peu 'r i l l a i r e w A<* aM t4 in p a r t i c o la r , Tro h z 70 u rre d t h a t tu b oat 3 e l o th c u lu .eot c r I - ,w. T - - 'l t n , -5! s i l b o t o b a r n t h i s r e p o r t s u r r e s t t h a t z r b - e t e a ; 1 bo ' a i - i l a r * t o o i l i c o a l a , s l t h a r i_2~Vo^ the'" p o r i o d - V.' - J - r V V n 'irar 3 r r * n , oc ,4 b 4 V A < -a 1 *n-- d a j e l a n , o r aa t o t h o d c a a r a r c c s i 7 od V7 ...o ^w....a, o r i j t o t.-.a iy. j;intit7 o f d u n * , e t c , ^ SSRoe? ^ f i s s e s . FK 8 n atta lzuror-toot) ta -- - * ` f f 7 . 1 n - a m a n t (rt-l ch s c o r o to na ir the authors pro?.; to'hsT. * *d - T , f ? " * 'C7 of t<> tlela. u , u o th e t t o t o s T O S I t o - i o ^ ^ r ^ t S S r ^ r 1^ to tf . h o ^ L t ' e ^ - r s - v : ! ^ 3: " r J t< r hao a s u .- .- ^ ;- *-3 s t a t e d i h i i o a t i ' ^ ' 0- - a o ' - "r ^ 1 , Hess r ot tn = 7 Ot-. - f u r t o o n T i ^ TCRdnrl.nrp -rhothor th --e r r i e t -- o f T' >-* tho correen t . - it a t r r n / n - r ' - J "u r " i i ** 1 r r a o u t in *hu f ` - 3 * t i; - 4 - , : " - 1 -'-*- .*.'m? - r r a d te i3 * * * "n to * OJ~ " crTa * " 7 :*:*-: e2n' i i a * 7--n3i^r^f4= 0*=-^ 1 1 7 d u e t. y - . , n_ o n ^ r *r ,> t i ^ t T1 3l ^- y--r _*:*~*arr i-r;i*th! 11- - * 7 r % it* bu *"* 4 - 5 C t * j coc *11 joc a r d X e r r r r l y **.** . *. -r-3 3 8 .cn hieb i-~oa^n in tbo iieport c f 1 ~ .' a - ?, C a i l o y 1 2 . Ho cotre:eut. S o In'1- , 1- . J " ! ,,0 r d ` : "n t " ` ' - `i * -- c a r te d a f t e r t i . e u - s iers slrscd7 callad uttiu t-cu o r r . 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I rfl ft ait4i II <14*ft 4-4T1 ; ? . d rfi ^ b o r4i ft tl I ft I 4 ft II Cl t `4 ' *rfj to 4* a I-ri ti I I H H to> 4 p A i W K ~ < 1 4 U t4 o 4* P O n / i i t i e " B 4* P Tl tll|l)D ir s -G g - r . to. r t r U i ti 1 1 H ri C A\ o o t l <> d 'ri 4b* \O4 -Irrt cu i r C Vri 4 *n1i p1 4, + 4 n M P r i (fi li ri rtf ri >i (1 li'o Vi Al C n u jJ : g O 4 L f t T i t l 4 K" (< r ! i,1 It>I!Il li O fi ri n IT r-4 \* O r. ti p. n r: o o ! 4-4 l l n fi <1 4 :,r n > Pl Inl r' n Vi f t -4*I t 4 t> > o u U / I |I CJ \ II!l Tl 4< t I n ' ri ri ri U r i II /* P 1C T l j ' r i cn: t-> ri n J; --i 0 O r i O ^1 t* r-4 M ri i * U U 4-4 b t; r U p J H |. ri 4 o 8 S P * -1^ A4i U p ) V -41 n u i ^ a r*. b 4* P 4 a: m n : 4 4 > ri < n n 4 IV M * , to - O C . g - ' . 1 1 0 K " -* p * o d f t 7? /J T4 tl m i : 4* ft P l> 4 o I) Il o o , #> 4 r r-4 A'. 4> D r 4 V 4 ri Il V. n o Ir i T t ri rf j ir*- M ft r r? O r i T l t 6 C r) M ^4 44 O Tl r-i * V U V. ft -I rf 4l>* 4to* Uo.T4 2u:n*-4?I; f.t u* o 41 o n -- Nt \ A i T II f t 4 4 4 B > - rt r T * j r: rfj Ir li r-l t i i * rt* f - ` *Ai o n n O (U 4 j : o p 4 ' I ; c t i o I n # 4 y ftr< o * a n Cr .l t n tr Mir I. J1 4* < f i 4 o o a : r-l t. \ c.i IO $r c .;1 Vi u e o P i V *r n V' r. Tv Hobart & Minard Lefcourt Building 1180 Raymond Boulevard Newark, New Jersey Dec. 15, 1934. Re preliminary study of Metropolitan Life Insurance Company Mr. Vandiver Brown, Attorney, Johns-Manville 22 E. 40th Street, New York City. Corporation, Dear Mr. Brown: I received your letter of December 10th with enclosures, including proof of the preliminary study entited, "Effects of the Inhalation of Asbestos Dust on the Lungs of Asbestos Workers". I have carefully examined the proof and return same. In reading this proof I have compared it with the paper of the same title which was prepared by the Industrial Health Service of the Metropolitan about three years ago. I submit the following suggestion (for convenience of reference I have numbered my comments in red pencil in the margin of the several pages of the galley proofs): (1) Gal. II. At the end of the paragraph which discusses the "variables" upon which the progress of the disease is influenced, the following sentence appears:- "It might well be assumed that similar variables would influence the occurrence of asbestosis." You will recall that in dealing with the New Jersey Legislative Commission which has had charge of the proposed new legislation in New Jersey whereby silicosis is to be added to the list of occupational diseases for which compensation is required under the terms of the compensation statute, we have consistently agreed that there is a substantial difference between silicosis and asbestosis -- both as to the clinical nature of the disease and as to the reasonable probability of its incidence, and you will also recall that in particular we have urged that asbestosis should not at the present time be included in the list of compensation diseases, for the reason that it is only within a comparatively recent time that asbestosis has been recognized by the medical and scientific professions as a disease -- in fact one of'our principal defenses in actions against the company on the common law theory of negligence has been that the scientific and medical knowledge has been insufficient until a very recent period to place upon the owners of plants or factories the burden or duty of taking special precautions against the possible onset of the disease to their employees. I, therefore, dislike to have this report suggest that asbestosis )fr\ l Xo'Tr Mr. Vandiver Brown, 2" might be assumed to be similar to silicosis, either as to the period of time within which it might develop, or as to the dosage received by the lungs, or as to the quantity of dust, etc. (2) Gal. 11. At the bottom of this galley I observe that there is set forth in a note (instead of in the body of the article) the statement that appears in the Report of 1931 relating to the enlargement of the particles and the use of logarithum (See p. 7 of Report of 1931) As a matter of curiosity I wonder why this statement (which seems to be quite important) is put in a note instead of in the body of the article. If the authors prepfer to have it in the form of a note, of course, their judgment should control, as it has no particular bearing in any event upon the points in which the company is interested. (3) Gal. 12. The last paragraph on this galley has a summary of the dust counts with respect to the several plants. I notice that it is stated that plant E "was unnecessarily dusty". I understand this does not in any way refer to any plant of Johns-Manville, but I am wondering whether the proprietor of plant E has had an opportunity to review the comment. It strikes me that the report would serve every purpose if we leave out in the first line of the paragraph on that galley the words "was unnecessarily dusty". Galley 13. No comment. (4) Gal. 14. The word "death" should be inserted after the words "6 of 36" in the third paragraph of subtitle "Insurance Claims". You have already called attention to this in your letter of December 10 to Dr. Lanza. (5) Gal. 14 under subtitle "Conclusions". No. 1. I agree with your suggestions in letter to Dr. Lanza of December 10th that there should be added to this conclusion a statement similar to that which appeared (at p.30) in the Report of 1931, namely, "Clinically, it is of a type milder than silicosis" -- or, if the doctors do not want to make the statement in that positive form, it might be as follows (an suggested in your letter): "Clinically, from this study it appeared to be of a type milder than silicosis"; or, if that is too strong, it might be set forth as follows; "So far as indicated by the study, asbestosis is of a type (or appears to be of a type) milder than silicosis". The exact wording is not important, except that I think it would be desirable (if the doctors are satisfied that such is the fact) except that I think it would be very helpful to have an official ^report to show that there is a substantial difference between asbestosis and silicosis; and by the same token it would be troublesome if an official report should appear from which the conclusion might be drawn that there is very little if any difference between the two d iseases. . Mr. Vandiver Brown 3 official report should appear from which the conclusion might be drawn there is very little if any difference between the two diseases. as No. 2. I understand that the statement/to the cardiac enlargement is correct from a scientific standpoint, and I do not see how we can consistently object to it. that No. 3. I agree that the word "preliminary" is superfluous. No. 4. O. I. No. 5. This reads the same as on page 21 of the Report of 1931 and, hence, it may be a little late to object. However, I point out that as No. 3 now reads the inference might be drawn that asbestosis does add to the mortality of tuberculosis cases. But that inference does not seem to be justified from this study. I am wondering if it would be a more accurate scientific statement if there were omitted from No. 5 the last three words, to-wit "other than tuberculosis". No. 6. This is the same as set forth on page 21 of Report of 1931, with the exception that the Report of 1931 at the end of the sentence has the words "than free silica (3102)" and the galley proof has the words "than granite dust". Hear again it may be a little late to criticize the statement, but I do not like the suggestion that there is a possiblility that asbestosis may cause pneumoconiosis more readily than granite dust. The reason I object is that many cases of silicosis are supposed to originate in granite dust and this statement as it now reads suggests that a possibility that a pneumoconiosis may arise more readily from asbhestos, than granite dust. I think we should, if possible, eliminate all that part of corelosion No. 6 following the semi-colon after the words "of air" in line 3 of the conclusion. No. 7. This is the same as in the Report of 1931. To comment. (6) Gal. 14 and 15 subtitle "Recommendations". In my copy of the Report of 1931 I have a pencil memo, as to recommendation No. 4 to insert the word "possible" before the word "effects" so as to have it read "as well as studies on the possible effects of asbestosis on the heart and circulation". I do not think the point is of much importance, but I call attention to it so that it is not overlooked. I agree with the other suggestions in your letter to Dr. Lanza of December 10th. very truly yours, GMH/HF Re-typed 2/14/95 Bridgeport, Geo. Jan. 2, 1935. Ur. Vandiver Brown, Attorney, Johns-llanville Corporation, Ne* fork City. Dear Ur. Brown Thank you for your le t te r o f Dec. 24. Both Ur. Simpson end c y s e lf fe e l quite * . safe in leaving the approval o f the report in your hands. I do think that Hr. Hobart made some excellent suggestions in his le t t e r of Dec.. 15, and hope that Dr. Lansa *111 give a l o t o f consideration to the comments. X take i t fo r granted that when th is a r tic le comes o ff the press, the Metropolitan Insurance Company *17 1 see that you get copies of i t , in which event, v e certain ly would lik e one fo r our f i l e s . lours very truly, MFJ-O, Secretary,. *1. .. r * P U B L IC H E A L T H R E P O S T S ' ' JA2HJA2X 4, 13SS N O .l EFFECTS OP THE INHALATION O F`ASBESTOS DUST ON THE LUNGS OP ASBESTOS W0BKE2S * AP n B m ia s r r Siadr By A 3. /Uiutaal MfiienL Director, tTnuaxat 3. IcCotzul, Auiti- cU Utditel Dintiar, tad 3, tTcxusi Fcxsrt, GurtiA, itttnfiUoA Lift ' InnmuM Co. ' .....................CfT20OCCa0K ' la 15)29 the'Metropolitan LiTo Insurance Co. was approached by nffwVH representing the asbestos industry in tbs United Slates, v ia n n desirous of ascertaining whether asbestos dust was an oecupa^ntiwl hozahi id tbwy establishments if so, what was the natura of this hazard and what should ba 'dona to prerent or control id * About this tima several articles had appeared in English medical journals n'wrTninj &pneumoconiosis duo to asbestos dust. IY1uIc in ona or two isolated tho 'occurrence of this typa of pneumo coniosis hod been described in'American journals, tho industry itself appeared to be quite uninformed of tHc existence of any such occupational disease.' ' . The hazard of fo** dost, with special reference to the lungs, has long been appreciated, and a great deal of study and research has been applied to the problem (in the metal mining and certain oilier industries) in Great Britain, the United States, tha British Do minions, and in other countries. The- nature of the edeem of silica dust expressed in tho term *'siliec3i5,\ with tha resultant entraordinary predisposition to pulmonary tuberculosis, is veil known. Theso effects hare been associated with the inhalation of dust con taining free silica in varying amounts. The effects upon the pul- nonary tissue of dusts containing combined silica--silicates--ere stm &ferrila field for inrestigatioa, but eridenca is accumulating that certain of these dusts produce pathological results quite cisunot from true silicosis. ' ^ The "asbeetosis" has been applied to the pneumoconiosis caused by asbestos dust and it wiil be so used in this report. Chem ically, the asbestos of commerce is a hydrated magnesium silicate consisting primarily of silica (combined silica) 4-4.1 percent, mag nesia 43 percent, and rater 12.9 percent, while ferrous iron aufisel aro present in small quantities. This commercial variety of 101334*--cs----i U) . . 01110 . k..3522s<- JOSSgwaG^gtS>g i 1ed prevent the solutioa o sorna o/ the dusts, particularly any siuca. jrhich might be present. The ansie^tr was actuated by on eicciri- . ea&j reren rotary pump and the rats o air sampled was measured, bx **** al s resistance type of.flow meter with aaineSncd manme-' ter or measuring the pressure difference. Each sample represents the dr*t e*n**t from a Telme o 100 cubic feet o air. The oleetrig precipitator is designed upon the Cottrell precipitator prrrpU used for w a t ering dusts and fuma commercially. This principia depends on electrifying the dust particles by making them pnf through an electrostatic field and thus causing them to settle out upon a sheet o celluloid. The electrostatic field is set up by o a transformer operating from the lighting Enes on 120 rolls, ytnmgrs> current. Air is drawn through the apparatus by a small rotary ion, run by &motor, the quantity being measured by a flow meter. ' ^ Samples o dust brushed from beams and pipe Enes near the csiung also were secured for cfaeroml analysis, i l l samples Tero shipped to `the hygiene laboratory of the Metropolitan Co., and the duat counts wen made according to the methods accepted by ilia United States Buns of and the United States Public Health Sendee (1). Particles in size up to 3fi0 microns in the greatest diameter wen counted. "-- . . ry w iW analyses wen modo for total (fres and combined) silica according to the accepted standard method o Eulebrand (3). In the fint plant studied (A) only pardales 10 microns and under in sisa wen counted. It hu boss demonstrated repeatedly that so jfif* particles ereeeding 10 microns (a micron equals oca-mQlionth part of a mater or one-thousandth part of a rmPimctcr) in greatest diametar enter the lung tiasu ; for this reason, tha larger particles usuaEy an cot considered when determining dust counts. Later, as it appeared from soma of the pubiished arricies (4) (English) that csbestos perriclss much larger in sisa wan found in lung tiwue, it 'ras deeded to count all particles and make diriennrial counts of all those 10 microns and under.' Total parricias per cubic foot and tha corresponding weight of the dust in willigra-* were obtained. Since co ndatioeship between the dust counts and the corresponding weights was found, die weights an cot included in the tabulations in this report. . . Table 1 shows by plants and by departments the mastnum end -sfmV,ffl dust counts in million particles per cubic foot of air. Although the counts in plant A an o partidas 10 microns and under, i M a o lir r m i S r b o a & a S a r t a a a t lt s t t ie ;ranr4rttar r a w r a s a O . la .m.lSsa, -- f e n a a s t o c s S S l of *- putici m atarse b r S e c : srcceat e r a i i e r a its a b i o a s - O U o n t a e a r . O a t n U g s id rtdr* M a t s u ^ m s r l f t S a r a t a r . S M rw n * -Ja t s s r m i i r s r r r s i (Sr iiiinniTl a r a * n t t la i-ir;.n iSa w e a s i p < U d * l a U). S t U w a n U s i n ' * (il raauuoaa ?arar, taa l o c a s e s * W isa f u n d a n la i* T i a a i-ra (!a t e n t a M a i m r a ) ** i taa prafiaatCW t< a o t a a n a a u o t e a * (\ v > V i j_ * '*^^r;M5P>^VA I J E ! ^ T~v' 'P5i<2^' J * -SSSh- ----.^T ti 4 4 r<i=a tad in tha other plants an for all particles, direct comparison 1s possible, os ia no sample taken were the number of particles 10 encrons and under less than 94 parant of the whale. Tima L--J/ iand minimum iaM anuth in wnllim purticLa ptr eaki*foul ' m t m i . U tr / n i / * A i M W n e i i i / * nm x IMS two ' naan KatZ SpwttSMt ofG O * bif on* PM UBH VTtiri pm* G* Bctar \Pm pm t tn h im tfc b< U km 3BCmi *** e a pr caoM fa*rf iir r tara ata lama pent* GAG* wnk too* Gr Ur^f no* P** Cadua inai* psxU* M o fwr mdo to** o. Kao Ur* MA* P*o P*r fflifrtr to** or MOEto pant* GAO* mo* to** W atJn o * lartrt tnlM U oA | )HU a to + n 9 j+- n K h a )h m i 4 < : t*-* bcMai taanti*. 1 A l t A by 4 1 | t 43 t o -u m 4 1 U * 4(4 | >i - m ; i^ m . i -r i 3 b- 3 39 * 3 i 'tH- r TTnareas the dust in tha preparation room is practically all duo to asbestos, the contrary is tho ease in the other departments. In the cardie?, spinning, and wears? rooms asbestos comprises about 25 percent of the material used. On special jobs the percents^ of asbestos mar bo ln?her, but in general tha figure quoted is approxi mately correct, tha other material consist? ptiacipaEy oi cotton. In the Insulada? departments of plant A, asbestos is but 5 percent of the total material used. la tha molded brake-lining and clutch `divisioa of plant D, asbestos ccmprhJS about 23 percent of the total material. The actual exposure to asbestos dial, therefore, is considorahiy less than U indicated in the dust counts in table 1. ' corramores ur thx n jjrrs ' The processes in these plant were rery jjmikr to thoso in cotton m ils in general. For Qlustration, the process in the preparation room of plans 3 is here decoded at length; Asbestos 3 received in baps. These are emptied upon the floor and the asbestos is shoveled into pc? suds and run for about 3 minutes m order to crush and open tho fliers. From there die asbestos a shoveled' into mucks anil wheeled Co hoppers with cither kuriacaUi or vertical openers, similar to thoso used in textile mills. After passing through tha opener, the material is discharged into trucks. *T7aste 1manuiacturin? material is first run through a garnet **<*-. -.-rl 5 >miT<i 1X3 discharged into trucks, which ore wheeled to tho openan, and tha material is fed into these in the same manner os is the now material. Alter being discharged from the opener, the material is put onto a vibrating or shaking screen, where tha long fibers are picked off o j a suction hood and blown into a bin to be used agem la textiles. The short fibers /oiling throagi the screen ire either sold os such or ased in making an asbestos cement. ` The cotton is received in bales, opened, and also run through vertical openers. It la discharged into trucks. Tho filled trucks /ram the rcrtical and horizontal openers containing eithar tho asbestos fiber, the cotton, or tho waste material ara taken to separate storage bins. As needed, these gr.terr.Js ara weighed and dumped onto tha floor in proportion to tha mixture desired, and tho resulting mi-ved materials an then passed through a mixing picker. As this mixture is discharged /ram the picker, it is sprayed with a light mineral oiL The material is then taken by a mecknnicnl conveyor to tho storaga ' bin in tho card room. Two 0/ these mixing pickers discharge onto this conveyor system, wha a third machina is equipped with a suction device which conveys the material to & storage bin in tha card room. The object 0/ the two systems is to /achitata tho handling 0/ two grzdrs 0/ material at tha seme time. The third machine Is not quipped with an o spray. Tho object 0/ the oil spray is pri marily to trap ths snail asbestos .fibers and hold them enmeshed in the cotton fiber throughout the processes 0/ carding, spinning, and weaving. Incidentally, it is apparent that it also diminishes ths amount 0/ dust. The material is saturated with about 4 percent of ad at this paint; but by the rime it reaches tha looms, tlrn oil had diminished to less thon 1 percent. . TOuIe mineral od was used in the preparation room of plant C, it apparently was not as Emcous as in plant 5 . In plant ZToil was not used, nor was there any attempt at humidification or any system 0/ dust exhausting. Carding wero fed by la plant A there was a humidifying, ventilating, and heating system, vhdo plant B depended on natural humidity. In plant Z the carding machines were equipped with a dust-exhaust system, but it was cot egeiencly used. In plant C carding was dona in 2 buddings, I of which was equipped with en eir-condidoning system, and in both beddings tho machines had exhaust equipment. Two plants, 3 and C, had irrificai humidity installerions in their spinning rooms. In the former the temperature was 75* F.t relarivo humidity 75 percent. Ono plant, C, had a humidification system in the twisting department and also in the weaving department, where tha relative humidity was 75 percent with a dry-buib temperature of 6i* F.f as compared with a relative humidity 0/ 44 percent in the weaving room of plant JL ..i* r r v^*:w.v.T^-- ...... - -- ailah*, & 7i--rr<ea @ d* from plant 2, it would appear that the dost hazard was aot erccssire oscape in tha preparation rooms of plants 3 and C. The dust counts are interesting, too, when considered in the light of the permissible standard for granite dust, established by the United States Public Eeaith Sorrica (7), namely, about 10 million particles d0 microns and under) per cubic foot. Howerer, wa are not jusrisod in assuming that because available information.sug^sts iW asbes- .tosis is^a milder disease clinically than silicosis, the threshold of . peraissiola dust counts is higher. Asbesiosis appears to be patho logically different from silicosis, and the experience so- far does not warrant an attempt to dance a standard of dustiness for asbestos dust. ... . Boar corrraot. . Various measures, such os oiling, humidification, and local exhausts, . tended to reduce tlxc dust. Nevertheless, it wns evident tliat they * were only partly successful H it is expected to control dustiness in these plants, finalreliance must rest upon properly constructed enhaust equipment. In plant C b ono department an erperimentai installa tion was set up. In spita of sono obvious faults, this equipment, on the basis of comparative dust counts, reduced the dust by 30 percent end with further alterations will probably be 73 percent effective. In this ease such a reduction seemed quite satisfactory. It k neitherpracticable sor economically desirable _tp instail such equipment as will msdeathe air entirely dust free. Thenocmal defensive mechanism of the body takas can of a fair amount of atmospheric pollution. It is when the body, is exposed to on excessive amount of dust that this defense mechanism breaks down. Tha application of exhaust equipment to textflo machinery involves considerable dimculty, especially where the construction of*the plant is such that it is not possible to apply down-draft suction to the looms. ' It is desirable to install enhaust apparatus in any plant on an pcrimental^ basis first, and then check its efficiency by dust counts. This practice wul result in sating a needless expenditure of money. . rsrszeu. iXAmnrariotrs _ 2-ray films were made of 123 persons (103 men,'IS women) working in asbestos plants in the United States. All but five of these were given physical examination. The cases were selected more or less at random from among those having more than 3 years of employ ment in the industry. It was soon obvious that the early diagnosis of asbesiosis must rest to a large extent on X-ray pictures of the chesty As in the ecriy stages of silicosis, the clinical symptoms of the asbestos workers were usually indefinite and inconclusive. The interpretations of these C os arc based on tho readings of one com- petent roentgenologist, but they lava been reviewed bv savored f " .. **r ' -ft?* "* ' * .? 5 * V V: fV\* '.*>.* lA * c '.-V1 .* r I odien experienced In tills field. Tlic differences of opinion were of &minor untare, mil then tm general agreement a to interpretation. The Chas worn read conservatively, talent into account the physical examination and the age of tlio individual, and were classed as powitrre only when then was so major disagreement. - Ail examinen fren guided by their experience in silicons and other types of pneu moconioses. The lllms.ciaased os negative for sshestesis were further subdivided into doubtful and negative. Only time can toil whether the individuis classed an doubtful aro progression toward a definite osbestosis. Particular attention iras focussed on the presento or absence of indicodocs of tuberculosis, and in this respect ail the reviewers of the dims were in accord. Tilth the unhappy experience of silicosis in mind, it was felt that a great deal of ears should bo devoted to ascertaining, if possible, whether or not osbestosis pre disposes to tuberculous infection. The esses of osbestosis were divided into two drat stage and second stags. Tha drat stags embraces, those who show by X-ray examination definite lung pathology sniaeiant in extent to warrant & diagnosis of pneumoconiosis, but who bava no dednito symptoms. Tha second-stags eases exhibit mora extensiva lung pathology and siso definita symptoms. AH these individuals * were actively engaged in factory work, and --- JsIp gL it was not practicable to make any distinction on the basis of working ability or disability. Had any individuals been found who exhibited extcusir pulmonary involvement and inrked physical disability or total disability, they would, have been classified os third stags, but so such eases were found. Cf the total of 128 X-ray examinations, 4 wero diagnosed as second'degreo osbestosis, 83 as first degree, 39 os doubtful, and 20 es negative. Thera is a definita increase in tha percentage diagnosed as positiva in reindon to the years of exposure, os shown in tabic 2. Sm-n numbers make it impossible to determina how far the factor of ags enters into this increase. T u t s 2.--di-u i,1extianofceua bf j r a r j tfarpoaurr X m a at upogen XUSUMT 9 S M l n fixiUv Xftstn gjyi 3f 1J 4 17 3in 12 i rX uo^i-K ^-'. c^affi^dLg-tirS'sa.. *^*-~.~- ^.Ti^r^r^.?r. .v-v; * r4,E3 8 Of the 64 persona given physical examination and diagnosed aa haring positive asbestosis, only S wars entirely free from symptoms, while 10 out of 37 with doubtfal and 7 out of 20 with, ergative diag noses were free from symptoms. Dyspnoea and cough were 'the symptoms most complained of, but none of these cases exhibited the urgent or evident type of "short wind" seen in true sElicosia. Several of those classed as negative stated that they were "short winded" and were so recorded, but too much emphasis should not be placed an statements of subjective symptoms. During the progress of the study, physicians who were practicing in the communities where asbestos workers lived were questioned and stated that they did not - find an unusual amount of tuberculosis runny these workers. The contrast between this state of affairs and that found in a community with a silicosis hanard is noteworthy. * * * The incidence of tuberculosis (based upou X-ray urns) is given in . table 3; 40 of the 67 examined had less than 13 years of employ ment in the industry. - XjLfltJ Incident* 9/ tusenrdont . Ta&n SeubCat Xfptln - -- 7. J M 1 1l a s a 1T ia M3yrm 4toccj J at profciAJj* m t 3 l * X c x r , * Table -1 gives information os to physical sigma of chest trouble. T a b u i j -- C X u l a d irti* . fMSn O-MStAti X-x33t- n a rris i *s* *t (Bnt tracM. ' XSatoassrsnusMij t ris.i -- ---- ratiL. n! *aTo c i At Wsft 4 i tttH i t o r t i to crld tq q lu e s s to d f i t s -to rtw ii. 11 Stott SOCU*4SH4 *v<tntCAOuifOStiiXmrtiit6ta/&^Hd tHsSiuI J.JtoKOfU. TThat sigciucauce, if any, can be attached to die presence of "asbestos- corns" on die hands of workers appears doubtful, as 13 percent of the positives (12 out of 64) end 13 peresat of the others (doubtful, 7 out of 37, negative, 2 out of 20) showed such cams. Each roentgenologist who renewed the X-ray Sims called attention to the fact that thus aims indicated a very unusual incidence of enlargement of tho.heart. It is probable that this is a comovusatory enlargement due to the additional work put upon die heart in efforts v i i * . 9 lMHT4,Sa to pomp blood through tbs fihrosed lungs. It. is possible that not sufficient attention has beca paid to the affects of the pcccmocoainsa upon tho heart.. ' . . Many workers had changed from ona deportment to mother and from one plant to another dcring their years 0/ employment In the asbestos industry. Since only the amounts 01 dust collected at the time 0f this surrey in the various departments ora known, them is so tray 0/ {moving the average amount 0 dust in the atmosphere inhaled by these people over the years of their employment. Conse quently, it is not possible- to correlate individual eases with rffn-'t amounts of dpst exposure. - . caonjcrcs wr.ir.ra ' . To throw light on the relationship between oabesiosis sjirj pulmo nary tuberculosis, on analysis of death claims and total and per- aanent disability claims was made in regard to carrying group insurance and having available figures. . ` Them wern 2,039 lir a involved, with a total exposure of 7,019 life- . years. The death claims an so small in number that reliable con clusions cannot be reached from any subdivision of the figura. Tlio same is true of the sickness claims under health insurance. The dumber of claims for respiratory disoasa is high in two of tha plants studied, but low for the others, os compared with the Metropolitan experience of 1927. However, during tha latter part cf 1923 oral the first part of 1929 then was an epidemic cidr.fiucnzn. Tho records of oca abiishment (plac B) showed that 0 of 33 death claims and 3 of 10 permanent and total disubliy claims wen listed as due to pulmonary tuberculosis. This appeared to be an in ordinate m ount of tuberculosis from this plant. However, many o f the employe wen Negroes, and also tuberculosis <?-?-< are gener ally high in this section of tho country. Realizing tho difficulty in diagnosing pneumoconiosis and the tendency to confuse it with tabercuicsis, these claims were studied mdividuaily. The physicians who had treated the individuals were interviewed, and the hospital and sanatorium records, including avail"bio X-ray films, wera investigated, with the following results: Dtath down: , 1- A typist, not exposed to dust; died of pulmonary ar.-j rntesthiol tuberculosis. . 2. Colored male, age 27; worked in asbestos I year and S months; died of pulmonary tuberculosis following a hemorrhage; was in sanatorium 10 months. Also had a four plus Wuss'er maun. No evidence of asocstosis. hi wy t a i 10 4. Colored mala, 059 34; worked la asbestos slant >___ , .,,d - u. beEcvcs this was a cisa^o'Tuncom- ^ os not uunato of hospital or sanatorium. mform-Laa could bo obtained on the other two cases. ' Total and vermantni disahiliiy aujttr ' * k Pi" 6 3 T643- H physician jtan."K?l ScaSseiSof-Stulb*er<Ucu^lLoasis abou11t142aybesavrns aaoftaerwaistUbeastnosoi*dmtral^b- g -M U r t* . il.o-lm c.uicr!^ ( f f g ^ S S i S . ta2UsaS L * f ipi03u i l l b est plant S months. Els physician SM toi? N f t J S lHth tubercle Pb a S flS 4 10 T"843' employment. Two phvsidans who A h " U u ltu T S 'iS ecrnann-io,.mT; uncoc.lubbing of "finc5"*s* odnbnrunnsnneaaheis^p^es'm,^on^; icnocleasrs'a2n0t . A-ray snows fine mottling dm-- *i.__1. t .. & "* " * k ^ r S L v 5t e ; * u iu T S b S .1b S i S !J S S . "^ * tajweulo. kmt a d tte d progressing in a satisfactory manner. ^ 43 It was net possible to locate tbs other, three cases of total and perman^t cisaoOity who had been diagnosed as haring pulmonary tuberculosis. On the basis of the information obtained, tho deaths in \ to bo *** l uncomplicated tuberculosis- to w of them ware Copies, wno wsra probably tuberculous at tho time their employment in the asbestos plant c la ss e d . 0 . ^th^diubiU ty claim cases, 1-xas nncomplicatad tuberculosis aod - wen tmeonpkeatea asbestesis who were nut on disabmtw became of a mistaken magaasis of tuberculosis. 12 this sar-e c-n - mmnjj we ,maw of oca dead: due to tmeompUcated asbestos in*m aarm ual with many years' employment in the industry. cosm esroxs 1. Rnlongcd expose to asbestos dust caused pulmonary fibrosis r 4- ous,nilt. ` = a u e s i and democstrabio on X-ray 5 ^ , 2 S ^ * " ^ h " 10 * ^ a typo mildera[S n fccnJ ;o -Vui-' ,--;. * - - 0Lii . . . . -~ ` .: .... ". . 11 3. A predisposition to tuberculosis ns to cabestoa tat woa cot indicated in this study. 4. As'oestosis oa observed in this sen s of eases hod not resulted in merited disability in 007 case.' '' 3. It ia not known how such aabestosia s & j add to the mortality of pneumonia and sente contcbereuioea pulmonary infections. . 6. It is not practicable as ja t to establish, standards for the asbestos dost content of air. ~ 7. .The amount of dust in the air in the asbestos plants studied can be substantially reduced. . . - ' szcotcrmnunoKa It is recommended--- . L That the industry seriously face the problem of sat corural in asbestos plans. * 2. That new employees be examined physically, including 2-ray examination of the cheat, and rejected for employment if they show tuberculosis or pneumoconiosis. * 3. That employees be examined physically, preferably every year, but at least every 2 yearn, tiiia examination to inclsao an X-ray examination of the cheat. ' 4. That the industry sponsor studies on known eases of aabestosia, as well os studies on effects of asbest&ia on tha heart and circulation. xcsrom.s3cusrT3 The authora wish to express their sincere thnuL-t to ail those who aided in makirg this study possible, especially the omci-ais and em ployees of tha asbestos companies who cooperated to-the fullest extent; and gnve every facility for securing'data; also to Dr. Pancaost, of tha University of Pennsylvania, for his interest and valuable odvica ia interpreting 2-ray Sims, and to Dr. F. w. Meriwether, of tho United States Public Health' Service, surgeon in charge of tha United States Bureau of Mines Cooperative Clinic in Picher, Ckha, whose inter pretation of ail the 2-ray Sims listed in this report is followed. Ap preciation is also expressed to Dr. W. Aimar Smith, ana Dr. Kenneth Lynch, of Charleston, S. C., for information and advice, particularly as to the pathology of ascestasis; ` to Dr. W. W. Wild, 0/ Charleston, S. C.; to Dr. Joseph E. Wyatt, of Newark, N. J., and Dr. E. E. Fellows, of New Tone, for assisting in interpreting 2-my dims; to Dr. Paul 0. Saoka, of Lasccster, Pa.; to Dr. IL H. Stevenson, of Danville, Quebec, Canada; and to Dr. L. U. Gardner and Mr. Dotuild H. Cummings, of the Saranac Laboratory, who have undertaken the study of s pathological effects of the inhibition of asbestos dust ^-M SSrn ^s^ ( ' I U m arr 4,133 12 through. animal erperimantation, with the aid cf &grant from tie Metropolitan Life Insurance Co. sxrm rscxs a) Greeaburp, Laormrd, m d Btoomialii, J. In T i Impiasar duai >jnptbj *ppanitna u tm d by tha Goliad State* RsblLe Health Sarrfcs. ib. H aiti Rep-, toL 7, so. 12, lU r. IS, 1032. Reprint no. 1323. 0) Drinker, RhSIp, end Thrmurm.'Robart M-` Doterminatloa of luspeo da by aU arsating-esm at p ra e p ta to a . Jour. lad . Hjtp, toL VH, co. S, Zaza 1923. ' (3) Hiliehnuri, TT. Tha aaslyde el siHeata u d earbonalo raelo. Bull. 122, Colled Stetea Geological Surrey, `Woehloptoo, D. C. W Cooke, VT. E i ?nlciORr.ry-jbrto>i. Brit. Mad. Jour-, Dee. 3, 1327. (3) Green, H-! A photamlerocmplde a n ttn d far the daierm ieatlaa of partlda tha at paint and robber plgaenta. Jour, JFoaklln laed tata, 1921, pp. 192, 837. () Whipple. G. d r Vital r titir d n . John WUcy ta d Seas, Iferw York, 1923, p . l. cn 3 iu *cL A. Z-, Britten, R. E-, Thompson, L. IL, ind J . * The health of worsen tn dotty trades. H . Hnposuro to nUeooua dost (g--miie Industry). ?ob. Health BulL Ho. 137. 1323. ENDEMIC TYPHUS Ef ALABAMA 3y J. H. B exre, M. D,, Jo u rs G. M c-U n ss, ?h. D-, and D. G. "Cua, JL D., D. ? IL , vUoooan Slate CrpcrtTninl ef UtelLK, ientfamer;, Ala, ' L EfTHOOCCTlOi* . In &preliminary report mads in Jena of this year before tha Con- ftraces of State and Prerincial Health Authorities, held In UFasc- irgton, the authors discussed tha epidemiological aspects a/ endemic typhus os it occurs in southern United Status. In that report it was noted that there had been a rapid increase in thTM disease in certain Southern States, as is shown in taLIe 1. That other coontries lm-re experienced a similar riso in icddencsTs e-ridenced by the figures in table 2. . The dijdncrioa feotween epidemic typhus and the endemic typhus of this country -arts 5re: recognised in IS9S by ErilL Ho (1) found in the United Static a type of ferer which, resembling typhoid, jit a oegntiro Widal reaction. In further studies ha (2, 3) demonstrated its similarity io typhus, bat showed that it was milder in character and less contagious, only one case as a rule being found in a household. Also be reported that it was most preroiont during tha fall of the year instead of lots winter or spring. In 1912 Anderson and Goldbcrgrr (4) proTed that 3riil's diwaso was immunologicoily identical with Meticon typhus, or tabarrHllo. Naturally this led to tlio belief that it was louse boms. HadtZMi.ar* ia* SSatsarr McCna *t is JLsuma rebiia 0*iiS H Trotlm , Ciiit, --- 'i- ... . a-..s..d...e...s.--tosis~ lanza toiny iir still in its infanrv pA.i . be cttanged as the survival'peri^^t?perat,ve observations may will * the s u r g i c a n i S " * d ' m c n A S m '|,,ln8!` at SaTM " Lake, N. y . ` Close operation between laboratory .elcc,lon of cases. and mereosurgcons is imperative in y "1vest,Eators, clinicians selectiion of cases for surgery and ,, , * ",ak'C t,lc best result, -nbtained, whether ,hey arc f . l l u ' S ' T t S i ^ ASBESTOSIS NE"WT Y*OR"K ' fa^ r f S f f i ,sc<i ^ patMlogy and clinically. Whcthc"Ci*ih!Sin ,l'TMnis in ils a disfarnet form 0f pulmonary rlnst ? 0S,S Wl11 rcmai'i to fete of a type coi 3 * d,,stfd,seasc or will prove to Ibe seen. " " "* of dusts remains tirami sfSicosis tin t Inc r ,n y pneumoconiosis, other i * d y front pathotor^t^^ch'1^ ?ons,'derabIc amount hygmrists. I^tnGiogr.sts. dm ,cans and industrial g K n a s r a i s s d fonnation so distinctive of silicosis ' d ' 1 ll` nodu,:'f .... 1924. there were two iiM977 C3SL not(d "as in and (he rest have occurred S e e 1 9 3 ? T,Ctl j" 1931 was supported by au(opsy ,, 1 bc d>ag,,0sis six the primary cause of dr-.in S X` 1 <)IK' f the another glioma of. the hrahi >,,?! was carcinoma. j,, tuberculosis. In the other thr'pp anot.,KT Pulmniiarv !* ~. cause, Some lliesc * S tom s, a s b e s to s is a S i S m e S A 'S ,,,a,,y cen' MO)'-" " ' a hydrated magnesium s ilin tAs Jestos. ( Canadian ) was 'diagnosed'!6se m "i b y ' ^ stc but about 44 per cent of ^ ir?nta,ni,1i? no free WM. SiTM, " c e s i u m , nearly 13 L Cc,n of? ' SlIica*,43 I*r nf [mn and nickel. While asbesto ' S and traces araewnts, the fabricating 0f sbestos n T ',ow" to tI,c ..... . comparatively n e w it receiver! 1 * a ,arSc scale is framm its use in connection wftl 3 tlcn'endous impetus s Te r riUCdlnnicaI Imposes. ' Jle? ami " fr a grcnt plants," th c1d!idea 1 p ictu rc^ f a -,fI fa,M'eaiiur than that of silicosis Tn C f as,,eslosis was mi: . terafuhiess0o ? rsb e sto fd m t1 ,? '9 i8 it possiblc with marked asbestosis will Sllrc-.thc "'dividual : , vicinal with silicosis. Tbere^is^'tbr' lescni,),c the ivm- exertion, the same ,|r,, , t,le s:""e dvspne:. ciann for workmen's comnenJ r f ''lg 1of a cltsabilitv Tire claimant was a foreman in tbe'" .Massachusetts. of an asbestos plant and the / wcav,n department Massachusetts Industrial L c i d e T Boa^ ' S tl,C twenty-seven years after the first fot i 3 d` T lls was m England by Dr M o n tam m o Case was reported again in 1934 a fatal case J L M u*ra/ : In 1910 and m 1928 the British Factory n S S 1,1 EnSland, and investigation and enacted l a J f o , u T n r T ^ an compensation of the worker P,rtection and whole subject in England iiS / S hls hazard- The Mcrewether.* At the present t' bee" sun" " arized by estimated, there are about 12 (K rr `T- "?ar,y as can be " ' I * chief whom 10,000 might be exnosed J ,Un,tccI States. of In 1927 a f ,Hl ? P c d to asbestos dust. reported to the Medical S o d e T ^ '^ ^ c asbestosis was 'f ;h' ". S f ,Card,i"a, -leven fatal cases reported in tl^ Tr' , ^ have been indefinite physical sism i'0^ i'i and tbe " " 're m j-. patient w i i i ^ tbe f tbosco,,' | not usually seen in silicosis . !1avc.cl,,bhe<l lm,.< faced and even show aT u ~ ,e ,s aPt to he ., ..ptient is npt t X while the Mb' , , m each instance I refer to nntf'S! ,'ing- 0 | c-ue complicated by infection whose disse b ,, was mined o f fabWc'atedtbe Uf ''^ ' vbicb hility and tuberculous in ferf6 iamdlar picture ni , rock mining coninn nities o,!' so, c laracteristi(: " Ported by the state. fur observations wen- , these communities All the ? P lysiclans practicim , : we detected we!! \vi pat'en!s 'ith asbestosis , at their trades. In onlvne excePtlc?n>working s n ; of active tuberculosis a n d f h f ^ r 0 d'd ' ve fincI evid,.... on the roentgen a l f ,, b d gnos,Is was based tuberculosis. Gardner and f . , Se'.'eial .showed head-! called attention to ! Cu,ni" ,ne s > their re..-:. i f yr'rip s r - * d-> s a ^ t a s L . ^ , va-v? r, rr .. ,;j "'complicated and three complicatoti!? ? l"es' ,eight f bese reports, together with ^i r by, tuberculosis, gured in the extraordinary ocem r 3Ct itbat as!,estosis T., nil put our clinical studv ....... . on that has spread over this comnrv"! i?3?6- Ii(iga` examinaiions" o f 'asbestos' F based 0,1 126 ,pli.y-ii'.-il oratoryand field 5UKl;es " `" r'S 'l' more than three years' evn V0' ' eiS'. ab whom had a -j ,--,cfo-r-e-- -------------- --------------o--a-r-d---------- --- L J ja r d at random. s x ty - S L o 'I T '! a"d 'V,' we sehrted --app--earan--c-e---w--hicnhj iweejmthoouugchrtliti'nbd^i,cPaute:sdc"atcpclneaiimro.xe-noincie-n 1 ,a Ri.inoti.m.IIanA, ,.F. L. RMioofhlamlitVjr Vfro' mJ'' Rde"s"n0iraIiJn,,-.1. 9.15 .......... 4, Gardner, J4, i(tlarrlioif t it . .. ! ~ ----_-___ --- ______ ileDartment nf i a; y Uiscascs in Dusty 1, I '""''"'OH of Aslieslos n.v.t Ural.,, Rep. Bo, ^ a"*"'''""ofI. Ar.'bWti*. FI.,,. -,, ''g l . i VoLUW E N umber 5 ^osis, bm ||.W e cal 1 dent pul Jgrams. patients. ^and tbir Ttinuing raddition "tnent an One i jTnvestig; `nnenacin Tappa re n: Ffactoric; lib t ava ^impressi jnade to |with tin [the Bril be extre art in 1 [have he< plants. * |abling a As in rgram. : ynterpreLical eviti ^studies, of pner ^ability ; Tsuch as ^.to find task in festiinatc ^.easier, jfhing, wt ^asbestos h The x |as in s' groupim jpatholog finer, j ^.asbestos in d the fflency 01 areas in |omewh _hng, ex feiay oce tpqueir U pturn S t- Of arts, ; W&t th e *nonary P'onclii, I t is 1 nay noi Pappe; jLUsts. ? Mrms plicate Possible phase e ifOne 1 Kjre nee Tv ( VoU.MK 11*0 S'l'JtUKK 5 A S 1 3 E S T 0 S IS -L A N Z A 369 I'STcIX xnV ^ and inconclusive. (lout pulmoiiarv svnmtoms m.,1^ iUr Prcscntmg evi- v J , , X T o t T Z S T ' 1* " - iKiiKius. twentv had lipcn c-c-rC i 1 1les.e sixty-seven i'l "rtccn n , ^ th>" . tinning nur asbestos stnrltnc^ s/ , arc st`H con- additional information on the timJ^l 10pC to secure with the roentgenogram before"11 cli" icaI Pictnre tosis is justified As imteri orc a .diagnosis of asbes- tional health hazards, there is^an "afi f herfoccl,Pa- tendcncy to make a diagnosis o h l disease because of presimm? vp n 3 t0 fref'uent flC oca'Pa(,naI out the corroboratio^of^othp^'pccil'r- f ? 0Sure withcorrect diagnosis One ;<= ,, Y CSS(:l'tial factors to a 4 is ,hat fc Briiis" menacing than wc did. This differr SCVeie a,.,d lllore apparent than real but it ic uTienCf llla^ be more diagnosis of asbestosis any more t l n S sT " -- ^ i 3 presence of a r n e n r 10*c tnan of silicosis in the pulmonary p a th o lo g i/c h a S ' * 10W,,,g no distinctivc may b T /n S ? not avadable auv c o m n in tL 1 r f En*Iish Tbere were i"ll"v>.-i..n is based on their renort 1 C?Unts> but tbis mad. mvself and mv rnllpam, tSi and 011 statcments iib the English conditions n 1CS by Pcrso'is familiar ilu- liritish ne P,rocess- described in be . M m n d S I L l , frCSS ,,,ak,,,g " a'id stated to I'ai ! !) tbis country In botha*1,>car ,to bave a counter- l,;i'r been taken to* >11^ 0^ i"'!1',eS' enerSctic steps so that'it is prob-Tble"'LT? 'Mzard in asbes^ abliii asbestosis will'be rare * CaSCS f dis S'1 " tb<=roentgeno- occurrencetCi!i the*V iZ n ^ 'a m U ?sbestos dust is the peculiar formation known as 1 l!lni.onai7 tissues of a asbestos bodies have bec X j S " ? ? bdles- These observers and an5 due J " P 3 nUmber of tissues on the asbestos fiber t I t le act!on^of the is doubtful, but it is commonlv leir C'Tact SISn*ficance tune that they are not di-umnstir as/ ee(j at the present and indicate merely that flip /?u. ,1,011ary fibrosis exposed to asbestos dust * Some VldlvlduaI. ,las been 'vl.e,. tlrac z s b J J M k s Z ttat, 5 r ,,,cy i'Klica`' - h s s s s &s s s Mil-; of aliii: 'eiunoconiosis ' as "ell as with maiTrrl a It! ' / c * d Severe *>Pe ^'"Ptom s and dis- tMotrir "iy colleagues and mvsdf ^?a H^611 aPPcarancc. m 'aite"mrptpiiAigvitoou^miakl on S. , ,^? t?S lTo[ .J^ibTcosSist,0moQu(rl tr'slKlilhc! !'e the extent of the ,1; 1 os,tlve d'ag'iosis and niiiv. ice (icsiribis the telm ic Un(S|'1tCS Plilllhc He!,IU' Ser' Peritoneal injection o[ n ,S v ? ,, T ! T " ,e of suspension. AIiiIcr defined M, CC(! dl'Sts 111 a state absorj)tive, inert and nrolifei t`' ee reaction: duced by reiati U barm e ^ - -lh e first is P'o- ond by dusts that n brl 0r ,n,act,ve dusts- the see the third as the typical reartf Pull,lonary fibrosis, and f ille r - described lhe ejects of th ReCent1^ varieties of asbestos; na.nely c l,m o tile ^ r three amosite. Cbrysotile is CanarltJ, 3 f ' crocldolite and viously stated* is larTM!,; nad,an.asbestos and, as pre lite aid amosite 3 i ,, n,a,,,e5,uni silicate- Crocfdo- as -iIicosis''anc^dQ1*notlend r dislinctive "r,"ipmg mto progressive sture* T , n,selves to ready |iaih.ii..yic changes in ihppri s '^ beie are less evident '"'er, i,,()rc granular and , n niS(jand .tbc shadows are mZ, r " " i r s ; 1 8l0S!: "skstosis lilinmves ociicv Ot the liodnlp fo ?fter ` ,an 111 silicosis. The " ,th ,ie consequent ten- magnesium, containing instead iron silT'i tluantity of mately the same quandty. ate 111 aPProxi' gaf toreraacstioinne*rtn. iHn Se ys^tatthees:'i? e tdleSsacudbbeedd Vby1'^tin?s3`"mevetystpie- rca^ 0,',d Usbr ,p,,am r ,hi= inert areas i,, t|lc ,]||))s 'J'lle c l i s t r i b u t i give, dcnsc Pa(lc somewhat liffcrent occmudni M \ f 1 le sha(|ows is '"".e. except in far\adva re 1 ' lo'vcr tl,ird of the may occupy the major portion n f il ' 1 ,C" `l10 sbado'vs frei|tientlv the well nniTcd n * 1C "r'^; Wc nticed septum oi, the right sWe Wp nt "6 ? t lC 'tcrlobar ,cr of fib, in cases of nspa f not,.cc< that a numI'earts, and this .,,,,ut i* asbcstosis showed enlarged by corresponding animal experhncnls with U* l,C? proven results from observation of naiMni* the same dusts, but 1 believe that the ^ ' 0,0* c 'V8*'TM 1 from autopsies, tissues has further strengthened^ht vn'T'' f asbeSf0S ll,e of dusts and thc intraperhoncal tt f Ur c,assification 'be harmful dusts by its cHnical c o rre L ^ T "5 f deterTMinin* * I- V '^ h o L ^ i c i e s i ^ s dt WhCn ne C "s i S ""nary blood A-csSe s w J ^ constrict thc^ul- I'roiicbioles.r the) ramify along with the ' !"ay no/1>c <!iSinc^iVc of 1 hiw hs,.PCiira,`1cc of Mbcstosis r dusatPs.|>earancc with pnoeenummoncroonmosiasscd,uaeloitUo!oltjhllet rusniilfiocarmte Is " d S e f i 5 ? U ? g elcancd^up ^ " T S E number of person ' e m C 'v p ? ; ^- W,t l tbe "Her probably never he the wedt ' n,^ 'S t,hat thcre will has been available in silicosis l i t " " material that that asbestosis l^ g r c es is L [ 110 .means certain draw.nl from dust S S J J ? ? S,I,.C" ,S .af`er witbbe as closely and intnnatclv asc ^"ef VlfcFfln seem to as with silicosis. The a n s \w t o W' / ' ?sbestosis lems resulting from cxonsnro t m an,d tlier prob- fiirther study both in the field and iu h p 1T * dc,nands Cniupa,,y thC 'ab0,at0r-V- 7* , , J e y " " ,c t '.Imonary Fibroses, J. A AI . A x o a T s i'o (SeJiV'Ts1) S 'n 'm m r "Td. ^ "te'ihSS! iI'ubP"nf<ait'h 1 J. I cr^nnnl commttnicah'nn 1,- ...1. * > * Silicosis and Asbestosis BY VARIOUS AUTHORS EDITED BY A. J. L a n za , M.D. W SISTANT M KDICAL IMKECTOR, M ETR O PO LITA N LI F t INSURANCE C O M PA N Y ; C H A IRM A N , INDUSTRIAL HY GIEN E CO M M U TEF. O F T H E NEW YORK TUBERCULOSIS AND HEA LTH ASSOCIATION OXFORD UNIVERSITY PRESS LONDON* NEW YORK. TORONTO ,J2<) SILICOSIS AND ASBESTOSIS esses in which dust control m easures can be readily instituted. As soon as the hazard was realized, in d u stria l firms fabricating asbestos took energetic steps to control the di^st so that it is probable that cases ol: asbestosis will becom e uncom m on. A recent report from the U nited States Public H ealth Service details dust control methods instituted in an asbestos textile plant which illustrates in a striking m anner w hat can be done to alleviate du st.2-5 Asbestosis has not appeared to be as serious a disease in the U nited States as it has in F.ngland, ju d g in g from the various reports from the latter country. Asbestos "mattress making," m entioned in the British reports as a serious hazard, is a process not found in this country. T h e role of infection in asbestosis is not as clearly defined as in silicosis a n d the clinical evidence available indicates that tuberculosis does not have the in tim ate reliTtionship w ith asbestosis th a t is so-conspicuous in silicosis.24 2S E ffects of Silicosis upon t h e Fa m ilies o f S ilicotics From the earliest times, w hen silicosis was first described as a disease of miners, the fact that the wife did not contract tuberculosis from the husband was m entioned and the many recent investigations have not upset this general conclusion. Hoirm an 26 staled in 1922, " T h e frequency of pulm onary tu berculosis among imm ediate relatives of granite cutters, but particularly wives, daughters, and m others, is m uch less than, as a m ere m atter of probability, w ould be assum ed to be the case." T h is was borne o u t by th e late r studies of M cFarland 27 and Russell.3* Cummings of the Saranac Laboratory, who investigated this subject in connection with the Pichcr Clinic, com m ented on the fact that, despite the wretched living conditions, and the lack of cleanliness and sanitation in m any hom es of advanced silicotics whose sputum was loaded w ith tu b ercle bacilli, no PUBLIC HEALTH AM ) ECONOMIC ASPECTS 421 adult type tuberculosis was found am ong exposed children up to the age of sixteen. Nevertheless, these various testimonies do not exclude the necessity of treating tubrculo-silicosis as a communicable disease and of m aking follow-up investigations of members of families of advanced or disabled silicotics, to determine the presence of tubercle infection or the desirability of segregat ing contacts from the diseased m em ber of the family. Sound public health procedure should be the rule and reliance should not be placed upon the supposed immunity of the family because the tuberculosis is com plicated by or conse quent upon silicosis. C o n tro l and P revention of Silicosis T h e control of silicosis is both an engineering and a medical problem , as are so m any other situations that concern the public health. Both the engineer and the physician, with their technicians, have their parts to play. In some instances, the medical phase may predom inate ; in others, the engineering, b u t it is seldom th at they can be separated or be independent of each other if a thorough job of prevention is to be done. E ngineering C ontrol T h e developm ent of silicosis is d e p e n d en t upon the dosage of silica and the m atter of avoiding a dangerous quantity m ight be thought simple. T h e lay m ind, familiar with the definiteness of the hazard of carbon m onoxide, and other toxic substances producing acute effects, usually fails to appreciate the inherent difficulties of establishing a threshold limit for a substance pro d u cin g a chronic disease whose development is measured in term s of years rather than hours. fro m tim e to tim e, critical com m ent is directed toward the industrial hygienist by the engineer because the former has failed to inform the latter of the sale or threshold lim it of Industrial hygiene ip TOXICOLOGY . ' ii.ii r..t iii i . . FRANK A. PATTY, E d ito r Contributors i J. BROZEK F. F. HEYROTH F. A. PATTY L. F. CURTISS F. R. HOLDEN L. SCHWARTZ E. E. DART G. W. JONES W. B. DEICHMANN R. A. KEHOE H. SPECHT .. J. H. STERN" ERJ r D. 0. HAMBLIN J. B. LITTLEFIELD J. F. TREON I. HARTMANN C. P. MCCORD W. N. W1THERIDGB <* ' VOLUME I 1948 ' IN TER SCIEN CE PUBLISHERS,' INC., NEW YORK INTERSCIENCE PUBLISHERS LTD., LONDON 511 OUST in the CAUSATION o r OCCUPATIONALDISEASE ,,uminnm b , physicians tor metallic aluminum available. Some mvestiga , However, when marked success in the treatment of purely objective criteria have bee ...somewhat less striking. Gardner, the suits have been and Delahant" have suggested that an d je^ ^ ^^ ^ ^ ^ variations in response to aluminum ^ P^ yt that du9t which is primarily free s s i s i ^ r i i s s s e s ,-* -- I. A3BESTOSI8 Asbestos is a hydrated mineral used m this country an '" tile mines. Asbestos is used in U o general yp be used either by itself or mixed with ceous earth for fireproofing, packing, of acturing processes. I t may materiala such as diatoma- ^ be combined with heat-resistant clothing and other t ^ a t th^re lunb^,e b , -- srnm. C iin ic ^ it - ' % " " s r 8c n t frequently found to be -- h * ith M^ipredisposiUon ^tiw nira^btyfcoai pnerunonia wrdacute nontuberenfous P e n a r y ,, eymptoto. - Symptom.. Tha onaat of aabeatr*, n!nr i " "^ " i a siliCMia f t a r . nmy b . . are apt to be mmewh.t more marke th marked x-ray findmes rnth 1ttla complmnt t W whereM the oppcaite h ^ omlill, , eymptom- w , to i d pr r i. - * * * - " j s s . . J . w . 0 . H a a a m n 1 C . f f : r i y g ; . ' ' ,, . T v l a l . I t . 2 U H W ) . m ' * * 1 <" * k d w a h u t . UAiir lVith u predominance in the upper portions of the prolifora- iectasis are fvcquoiU, ospocinlly in ^ ion in lion exposure, it is iml,K'c'lhy( classified among the inert dusts. Microscopic Anatomy. Johnstone do^ ......* microscopie appearance of f tho dison*so there is thickening the lungs somewhat as follows: in t ie cm y of the alveolar septa which icsul snaces contain numerous phagocytes. W\ proliferation. The alveolar .,rORression of the disease fibrosis be- \ 6 disappears, ami in its place X * nunc marked; Ik. ^ ^ ^ 5 . .1 there is now dense fibrous tissue, ho feu 1 ^ ^ ulin0rit glandular appearance, are lined with low cubo.dnl epithelium g t diseased ^ llouUhy parts are Scattered throughout the ung > Ni cponald.7' These bodies are 20 to spindle-shaped structures described first y ^ lhey u, d u b - o r ,, 100 a in length and arc bul^ . dumbbell-shaped. They re biounibh m i reaction for iron, dinwon" luis produccd^t do not stain, and give a I'rus,ian-bluc ^ hiea piKsb y experimental . > V concludes that these "curious exposure to atmosphere n ecc-m ly indicnle asbestos,s. `" S utSc tabuiated below : Abtslosi fibrosis diffuse (film may have ground ` Blnss appcttraacc from pleural mvolvo- FiiuUugs may lw either bilateral nr uni- u S L e l y ' . n the lowor o-.o half or two thirds of lb! lung ,u- y3- f . Emphysema in upper portion of lung fietcla. ^ n,,a Siliroit Fibrosis nodular. ` Findings ehar.icLuislienlly bibuornt. Usioiii-pwlomiima.lv In the upper Iwo- tbirds of ibe lung boms- , , Emphysema in lower portion of Umg fiotds. t0 = " L.U. Gardner, fad. ,Wed.. 9, (19W) R. T. Johnstone, O c cu p era ( Philadelphia, 10-12 " S. McDonald, Dnl. -i , ^ I?T5(i^ S ) *>F. W.Simsou, Dni. MeJ.J-, b 835 ' 1047 (1930). .,,. , , 11 K. M. Lynch, J. iu siiii:o;1:, ,,,..1 A.-bcUo^, "E . 1. Pendergrass, R-atgu - > K,.- York, 1W8 U ,, M, Silicosis ami A s b M * . Oxford U.v I . - L .p v i.';- '; til 1 i DUST IN THE CAUSATION OK OCCUPATIONAL DISEASE 513 Drccsscn, DulluVulle, EilwiucJs, Millur, and Sayers" have found evidence to indicate th at 5,000,000 particles per cubic foot of air is a satisfactory figure for tho maximum permissible atmospheric concentration of asbestos to which workers may be exposed. Definite permissible standards, however, have not been established. VI; Dust Causing Mluhuul Fibrosis or No Fibrosis , Gardner" hns pointed out that any known inorganic dust other than free silica and the asbestos silicates may produeo nonspecific dust reactions, as described on page 480. X-ray markings may be found in other conditions such as chronic infection and heart disease. No interference with pulmonary function or disability is produced by dust of.this type and there is no influence on susceptibility to tuberculosis. * ' A. SILICATES ; McCord," from u number of Bournes, bun compiled a list of tho commonly used silicates, which is presented hero: ' . ' '" 0/iVine--a magnesium silicate widely present In nil bnslc rocks.. Many vmlctics of lids si one nro known. Calcium silicate--nonexistent In nature, but n common product of industry; may bo found al % blast furnaces and in production of cement and hydrated limes. Other 9ilh'ntes of culclum nro known. ' ' 1- H'i/fruiiff--a zinc silicate (rare). . Sodium ilicale (mein)--tho well-known water-solublo silicate, commonly called water glass. This is widely used in industry, notably as a fdler in soaps. This is the only crystalline silieato of sodium, the others boing amorphous glass, ` ' TnmolHe--a magnesium-calcium silicate.. ' Aul/csloa--tremolite, arlinolite, chrysolite, or amianthus, all of which me essentially mag nesium silicates. , . . ' Jm/er-anotlier form of muguesium:euluium silicate. , . , . . Crocidolile--"blue usbestos." It is,a sodium Iron silicate. . Talc--a hydrated mugnesium silicate with extensivo industrial application. ' Soapslone--a form of talc. . . . . Affalile--a variety of talc resembling asbestos, ll is used in the coaling of paper, and as a paper filler. ', . . ' , . Mtertchanm---also called sepiolile. It is closely akin to title. , . Serpentine--hydrated silicate of magnesium. It is a common building Mono. 5h7/iwnifc--aluminum-containing silicate. The source of many stone tools of the stone ago . Topat--a semiprecious.stono of silicuto origin. Chemically ll is an aluminum (luosillcalo. Fuller't earth--a hydrated silica-aluminum compound, associated with furrio oxldo. . Kaolin (kaolm lc)--many related silicates of mixed constituency. Clay--hydrated aluminum silicates containing Iron. Titanium, quartz and mica, are likely to be presont in clays. - . 'MV. C. Drccsscn, J. M, DalldVnlU;, T. I. Edwards, .1. IV.. Mill, r, amt ll. R. S ayo. U.S. Pub, Health Dull. No, 241 (1933). . VC. P. McCord, /inf. Med.. 2, 4 (UM).