Document 4Qy52EEdO5xza41mg5RXLvO5p

FILE NAME Owens Corning OC DATE 1935 DOC OC431 DOCUMENT DESCRIPTION US Gov Report - Effects of the Inhalation of Asbestos Dust on the Lungs of Asbestos Workers PLAINTIFFS EXHIBIT NO 0-01 CASE NO BML 1/87 1/87 1/87 5 1/87 IDENTIFICATION ADMITTED Tee 2 Orme ek | U.S. TREASURY DEPARTMENT HENRY MORGENTHAU 32 Secretary PUBLIC HEALTH SERVICE HUGE S. CUMMING Surgeon General EFFECTS OF THE INHALATION OF ASBESTOS DUST ON THE LUNGS OF ASBESTOS WORKERS BY A. J. LANZA _ Assistant Medical Director WILLIAM J. McCONNELL Assistant Medical Director AND J. WILLIAM FEHNEL Chemist Metropolitan Life Insurance Co. REPRINT No. 1665 FROM THE PUBLIC HEALTH REPORTS VOL 80 No. 1 JANUARY 4 1885 Pag 1-12 OWENS CORNING | FIBERGLAS CORP LEGAL & PATENT DEPT REC'D SEP 15 1941 UNITED STATES GOVERNMENT PRINTING OFFICE WASHINGTONWASHINGTON 1934 For me by the Superintendent of Documents Washington D. se we ee + ee ae ee y or eee bal TT ee ay. > t .- OF ASBESTOS DUST ON EFFECTS OF THE INHALATION ; THE LUNGS INHALATION INHALATION ASBESTOS . Preliminary Study Witutaw J. McCorneuL, Asnsl- By By A. LANZA Assistant Medical Director WILliam McConnell McConnell Asriel- ant Medical Director and J. Director Insurance Co. a INTRODUCTION Co. was approached by In 1929 the Metropolitan Life Insurance Co. was approached approached by the asbestos industry officials representing whether asbestos United States States who were desirous of ascertaining asbestos asbestos what was an occupa- occupa- tional hazard in their establishments was the nature . of this hazard and what should done done prevent prevent English control medical articles had appeared medical in English About this time several to asbestos asbestos pneumoconiosis describing pneumoconiosis this type of While pneumo- journals coniosis had isolated instances occurrence occurrence industry pneumo- pneumo- coniosis appeared had been described American American journals existence any such itself occupational to be quite uninformed the existence occupational disease reference the lunga has has been appreciated appreciated silica dust special special study and research research has been applied appreciated and great great of and certain other other industries industries Great Great problem the metal mining the British Do- Do- minions in other Britain United naUtunreitneadture the effects of silica silica expressed expressed in the countries the resultant resultant extraor- silicosis dinary predisposition predisposition to pulmonary tuberculosis well known known pulmonary These have associated the inhalation inhalation dust con- con- taining free in varying associated upon the pul- pul- monary tissue of dusts containing amounts effects silicates containing combined acumulating accumulating that fertile field for investigation evidence evidence these dusts produce pathological from from certain of quite distinct pathological silicosis silicosis these produce produce pneumoconiosis statstimeandaa commercial pneumoconiosis The name asbestosis silicate silicate statstimeandaa percent been dust will applied to the pneumoconiosis Chem- by asbestos ically commerce commerce is a hydrated hydrated this report report Chem- Chem- the asbestos asbestos combined silica magnesium consisting primarily primarily silica combined 44.1 percent mag- mag- percent and water 12.9 ferrous iron and and nickel present present small quantities quantities This variety of of ... nickel are 17 statstimeanda en ane de ded . pW pantie oped cay af Y TET, r \ PRE UE WES TU t ~~ re % 3 rie i = f . ~ when wt New me . -& orca, --s, ee TONS 9. DIE BREET 7 all ~ Pintle ecs er Se naA piers So eee ee eepooner riers ek etre Aap Fy Tele ce Be rea Mars al 7 . 4; 4 a 4 ce Loree Pan 7 MS wee Te wes St : an . Poet ., oot a So a ee er ~1 Petegt ry : oan 2 EFFECTS OF ASBESTOS DUST ON THE LUNGS asbestos most commonly encountered is designated as chrysotile and is one of the four varieties of the mineral serpentine in which it usually occurs in seams It should be borne in mind that silicosis and presumably asbes- tosis develops very slowly taking from 5 to 15 and even 20 or 25 to become established This rate of progress is influenced years mainly by the dosage of silica which the lungs receive and this dos- three variables amount of silica in age in turn depends upon the dust the quantity of dust in the air and the length of exposure Individual idiosyncrasy might be included as a fourth variable however little is known of the variations in susceptibility in those exposed to dust It might well be assumed that similar variables would influence the occurrence of asbestosis . where asbestos is mined or fabricated in North America there In pdlaoceess not appear to be present the clear clinical picture silicosis hazard there which is so unescapable in communities with a true of the such as hard mining communities It may be that some are of too recent origin for the typical effects of a asbestos plants but this would not apply to the milicate dust to become manifest , = older mines or to halelalotfhthseerfvaibcreicoaftitnhge pMleatnrtospolitan Life Insurance T Coh. eundiendrutsotorkialthe following investigation during the period from States October 1929 to January 1931 which included 1. study of dust conditions in asbestos mines and mills in Canada and in fabricating plants along the Atlantic Seaboard in the United . including examinations 2. Physical examinations of asbestos workers including ray 3. A study of dust exhaust systems designed to eliminate asbestos dust are .Data on the fabricating plants only are included in this study and are designated in the report as plants A C D and E. This is preliminary report A more extensiveextensive study of the asbestos industry js now under way . tot py. DUST STUDIES ils Both Apparatus and methods of sampling the impinger 1 and the electric precipitator 2levweelr s eanudseidn cflorostehperocoxlilmeicttyiotno otfheaiwrosrakmpmleens for dusts at the breathing of are adapted for this work as they Baroethtroafnsthpeosretafbolremseasilyapspeatrautpusand adjusted for the taking of the samples at the proper level and are extremely efficient ,, The impinger collects the dust by aspirating the air and then impinging it onto a flat surface covered by a liquid in a container iTmhpiengilnigquid used was distilled water containing 50 percent alcohol to J . nickel nickel nickel - are present in staatus staatus staatus staatus staatus : and oe ~ Ce eee eee GA ay moe 9 em) tae a : & Ba o RE = eee RRee - A So aio oP beet er SS tee a MS Ste pe a te Notes: att . ec. _ plein Rae 4 A erage :, aM . . - lien) - [be USE ate Crp: EY Cn weal oo hiigin nm EFFECTS OF ASBESTOS DUST ON THE LUNGS 3 4 reLae aity4: ie Reney ow eaee eee resPaes BR aes Re aad ME Fes ea ae acer ae ce See TREYyor : prevent the solution of some of the dusts particularly any silica which might be present The impinger was actuated by an electrically driven rotary pump and the rate of air sampled was measured by means of a resistance type of flow meter with an inclined manomster for measuring the pressure difference Each sample represents the dust collected from a volume of 100 cubic feet of air The electric precipitator is designed upon the Cottrell precipitator principle used for recovering dusts and fumes commercially This principle depends on electrifying the dust particles by making them pass through an electrostatic field and thus causing them to settle out upon a sheet of celluloid The electrostatic field is set up by means of transformer operating from the lighting lines on 120 volts alternating current Air is drawn through the apparatus by a small rotary fan run by a motor the quantity being measured by a flow Samples of dust brushed from beams and pipe lines near the ceiling also were secured for chemical analysis All samples were shipped to the industrial hygiene laboratory of the Metropolitan Co. and the dust counts were made according to the methods accepted by the United States Bureau of Mines and the United States Public Health Service 1 Particles in size up to 360 microns in the greatest diameter were counted Chemical analyses were made for total free and combined silica ' according to the accepted standard method of Hillebrand 3 In the first plant studied A only particles 10 microns and under in size were counted It has been demonstrated repeatedly that no silica particles exceeding 10 microns a micron equals millionth part of a meter or thousandth part of a millimeter in greatest diameter enter the lung tissu ; for this reason the larger particles usually are not considered when determining dust counts Later as it appeared from some of the published articles 4 English that asbestos particles much larger in size were found in lung tissue it was decided to count all particles and make differential counts of all those 10 microns and under Total particles per cubic foot and the corresponding weight of the dust in milligrams were obtained Since no relationship between the dust counts and the corresponding weights was found the weights ; are not included in the tabulations in this report f Table 1 shows by plants and by departments the maximum and o minimum dust counts in million particles per cubic foot of air Although the counts in plant A are of particles 10 microns and under iS reat AA q ; 1 Samples collected by both the impinger and the slectric precipitator wars counted In addition microphotographs of these dust particles ware enlarged by being projected upon a areen with a lantern- alide projectar the enlarged meas beiu ng r meae surd ed a rulre ulr er Knowthie n entig re anlargement by actual measurement it was sary to muleniste the original particle size mansured By the use of Hasan's 8 ogarithmioprobability paper the logarithms of the function to be mansured in this case microns are plotted as ordinates against the probability of occurremos as abeclames i de Od 4 Pea yAee Ae ~ 2 essae aeqik' reas Eves4 a u * ~ 2 wap 2} me rey 3 . - . ate - fee . 2. y- Sl = _ me tee . - Ce Pears: te Seat we eas 4 EFFECTS OF ASBESTOS DUST ON THE LUNGS and in the other plants are for all particles direct comparison is Ff possible as in no sample taken were the number of particles 10 yi microns and under less than 94 percent of the whole " * i TABLE Marimum and minimum dust counts in million particles per cubic foot of air by plant and department . 4 . 4 . . ': _ *e. eT : ay Plant & Plant B Plant C Plant D Plant E : Milboo | F Nam Million Molion Milboo MINOD MINOD Million Million bes of Million y | || | Num- Num- parti NuNumm-- NN uum m parts- Nu Num m partr sam paru- of Department cles ber of : pasl per under Dies Department 10m 1 | parts- | partr per | paru- per ber of ber ber per r. ples 10m pe pies cubic ples cuaibric foot --ples cubic | cufoboil e taked taken taken cubie cubic i foot of foot of foot of fool of ~ . Laken foot of er foot of Preparation | Card room Ring frame room spinning Mule spinning Wresting Twisting Felt departmeDt ---- Sheet inswating Molded brake band and clutch . 8} 3] Heiwl r in Yet ... ... ty 2 +3 @} aris MGADUN eh MGADUN ah $ MGADUN | Ho Mrccceee] MGADUN Ho [OS] MGADUN teh MGADUN . 1-1 CY eowe sfeoversels 3h 114-41 114-41 api - 14 ,6 | 81-10 , 2] he ad * Included in spinning Includes broad loom weaving tho 88 47 47 469-7 2 54-10 54-10 $ 469-7 469-7 1461-4018 1461-44018 eaeccacee ea . . yg 2 ws Be _ a % Whereas the dust in the preparation room is practically all due to asbestos the contrary is the case in the other departments In the B carding spinning and weaving rooms asbestos comprises about 25 g percent of the material used On special jobs the percentage of asbestos may be higher but in general the figure quoted is approxi- mately correct the other material consisting principally of cotton In the insulating departments of plant A asbestos is but 5 percent of the total material used In the molded lining and clutch division of plant D asbestos comprises about 25 percent of the total material The actual exposure to asbestos dust therefore is consid- . arably less than is indicated in the dust counts in table 1 CONDITIONS IN THE PLANTS : The processes in these plants were very similar to those in cotton mills in general For illustration the process in the preparation room , of plant B is here detailed at length - . +. ! Asbestos is received in bags These are emptied upon the floor and the asbestos is shoveled into pug mills and run for about 5 minutes in order to crush and open the fibers From there the asbestos is shoveled into trucks and wheeled to hoppers with either horizontal -~ or vertical openers similar to those used in textile mills After passing through the opener the material is discharged into trucks Waste manufacturing material is first run through a garnet machine and . Wee e+ ee ae saresane tel ee oe | . nara Ser htan . Rbdieseneieentecend 3 cE + es OEot:Reet :NETL,. we . Say F Br Crs Spawn Leaaa 5 Dae Stigai: ; Sorte Se Ree a reas 4 Oy SPATed!oth $08} EFFECTS OF ASBESTOS DUST ON THE LUNGS 5 discharged into trucks which are wheeled to the openers and the material is fed into these in the same manner as is the new material After being discharged from the opener the material is put onto a vibrating or shaking screen where the long fibers are picked off by a suction hood and blown into a bin to be used again in textiles The short fibers falling through the screen are either sold as such or used in making an asbestos cement The cotton is received in bales opened and also run through vertical openers It is discharged into trucks The filled trucks from the vertical and horizontal openers containing either the asbestos fiber the cotton or the waste material are taken to separate storage bins As needed these materials are weighed and dumped onto the floor in proportion to the mixture desired and the resulting mixed materials are then passed through a mixing picker As this mixture is discharged from the picker it is sprayed with a light mineral oil The material is then taken by a mechanical conveyor to the storage bin in the card room Two of these mixing pickers discharge onto this conveyor system while a third machine is equipped with a suction device which conveys the material to a storage bin in the card room The object of the two systems is to facilitate the bandling of two grades of material at the same time The third machine is not equipped with an oil spray The object of the oil spray is primarily to entrap the small asbestos fibers and hold them enmeshed in the cotton fiber throughout the processes of carding spinning and weaving Incidentally it is apparent that it also diminishes the amount of dust The material is saturated with about 4 percent of oil at this point but by the time it reaches the looms the oil had diminished to less than 1 percent While mineral oil was used in the preparation room of plant C it apparently was not as efficacious as in plant B. In plant E oil was not used nor was there any attempt at humidification or any system of dust exhausting Carding machines were fed by hand In plant A there was a bumidifying ventilating and heating system while plant B depended on natural humidity In plant E the carding machines were equipped with a exhaust system but it was not efficiently used In plant C carding was done in 2 buildings 1 of ~fl which was equipped with an conditioning system and in both buildings the machines had exhaust equipment Two plants B and C had artificial humidity installations in their spinning rooms In the former the temperature was 76 F. relative humidity 78 percent One plant C had a humidification system in the twisting department and also in the weaving department where the relative humidity was 76 percent with a bulb temperature of 69 F. as compared with a relative humidity of 44 percent in the weaving room of plant A. yytee eS Bee De aren SY e ietsat \ ey a ers xwe Cwertenia ; ee ~~ See 3% 203s espe Sas tid ae sie bo Bere: Re amieseeaaon Beet Sg 9 ES BIS Be eee X we 8S Ee ea CES Sub 7 2, Me $2 = rast Rs, EFFECTS OF ASBESTOS DUST ON THE LUNGS % a ... nTohte- patho- Aside from plant E it would appear that the dust hazard was excessive except in the preparation rooms of plants B and -E-= dust counts are interesting too when considered in the light of the "v fa-e standard for granite dust established by the United- permissible namely about 10 million particles States Public Health Service 7 cubic foot However we are not justified SBS 10 microns and under per information suggests that asbes srs in assuming that because available silicosis the thresholodf #6> . tosis is a milder disease clinically than dust counts is higher Asbestosis appears to be permissible from silicosis and the experience so far does not se logically different standard of dustiness for asbestos ee warrant an attempt to define a . veo asbestos dust . DUST CONTROL an a ae exehxahuasuts experimental such as oiling humidification and local me Various measures tended to reduce the dust Nevertheless it was evident that they S&- to control dustiness a were only partly successful If it is expected #5" final reliance must rest upon properly constructed ee these plants an installs In plant C in one department faults this equipment o equipment = tion was set up spite of some obvious reduced the dust by 50 percent the basis of comparative dust counts be 75 percent effective and with further alterations will probably such a reduction seemed quite satisfactory It is neither; In this case economically desirable to install such equipment mechanism practicable nor will make the air entirely dust free The normal defensive mechanism Fs) of atmospheric pollution mechanism of the body takes care of a fair amount amount of dust that the : is when the body is exposed to an excessive that defense mechanism breaks down : involv of exhaust equipment to textile machinery The application where the construction of the plant 3 considerable difficulty especially draft suction to the loom is such that it is not possible to apply an ex- It is desirable to install exhaust apparatus in any plant on first and counte perimental basis then check its efficiency by dust ; needless expenditure of money This practice will result in saving a . e. ocmk PHYSICAL EXAMINATIONS oe fest 7 working made of 126 persons 108 men 18 women ray films were the United States All but five of these were f in asbestos plants in examination The cases were selected more or les % of employ- given physical those having more than 3 years random from among at obvious that the early diagnosis # ment in the industry It was soon of the of asbestosis must rest to a large extent on ray pictures sustinbestions the early de sustinbestions stages of silicosis the clinical symptoms 4, sustinbestions sutinbestions ~ workers were usuallyindefinite inconclusive - The Qs the asbestos based on the readings of one com interpretations of these films are been reviewed by several 27. .petent roentgenologist but they have oe = fe : = ost : 0 Soe . a aa, =a - enc AOE, $i aera aa ean ign, . er: : A A . } : ax* . a fs . an me : a x - * =i we sO an ise sa o n ot, . Soe Ps > re aa Eee = Bc #8 EFFECTS OF ASBESTOS DUST ON THE LUNGS 7 interpretation others experienced in this field The differences of a minor nature and there was opinion were of The films were read general agreement as to examination and theconservatively taking into account the physical age positive only when there of the individual and were classed as were guided by their was no major disagreement All examiners moconioses The experience films in silicosis and other types of pneu- classed as negative for asbestosis subdivided into doubtful and were further whether the individuals classed as dnoeugbattfiuvleareOnly time can tell definite asbestosis Particular attention progressing toward a or absence of indications of was focussed on the presence reviewers of the films tuberculosis and in this respect all the were in accord With the unhappy experience of silicosis in mind it was felt that a great deal of devoted to ascertaining if possible whether care should be disposes to tuberculous infection or not asbestosis pre- . symptoms The cases of asbestosis were divided into two and second stage The first classes first stage stage embraces those who show by ray examination definite lung pathology sufficient in extent to warrant a diagnosis of symptoms The pneumoconiosis but who have no definite second pathology and also definite cases exhibit more extensive lung ' All these individuals ? were actively engaged in factory work and ability or disability Had any individuals been found who extensive pulmonary involvement and exhibited or total disability they would have beemnarclkaessdifipehdysaiscalthidridsasbitlaigtey but no such cases were found Of the total of 126 ray examinations 4 were degree asbestosis 63 as first degree 39 diagnosed as negative as doubtful and 20 as . There is a definite increase in the in relation to the percentage diagnosed as positive numbers make it years of exposure as shown in table 2. Small enters into this incirmepaossesible to determine how far the factor of age Table Classification of cases by years of exposure , Years of exposure Percentage positive Number Doubtful Positive | Doubtful Negative year year Over 18 10 to 15 & 10 years . . Bader 6 year / year / Total examined * 6080 3 1 6080 ? 3 t3 6080 po st. 2 6080 17 10 123 -| Cd ry 2 : ! men One asbestos time 5. to this study worker second but is still stage retired of his own active about his garden . # sot qputingoms accord because of old fy agu fete Mae a, 10 years previous  oe ea -...* EN Su pes . Sa . 1 panel) Seer ee : RE gc t . ; oad ~ ene we eee oes ven cueew evens aie VN 2 te - Apert te ei eae aa BS Senge Na \ 1 vote Ain Ee aS cs eis Sw iad Parry 8 EFFECTS OF ASBESTOS DUST ON THE LUNGS - Of the 64 persons given physical examination and diagnosed as having positive asbestosis only 8 were entirely free from symptoms while 10 out of 37 with doubtful and 7 out of 20 with negative diagnoses 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 silicosis Several of those classed as negative stated that they were short winded and were so recorded but too much emphasis should not be placed on 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 among these workers The contrast between this state of affairs and that found in a community with a silicosis hazard is noteworthy The incidence of tuberculosis based upon ray films is given in table 3 40 of the 67 examined had less than 15 years of employment in the industry Table Incidence of tuberculosis Tuberculosis bealed Tuberculosis active Tuberculosis active Positive | Doubtful | Negative - own 4 800 20 1 This case was diagnosed as probably active on the ray Endinga Table 4 gives information as to physical signs of chest trouble : Table Chest findings Positive | Doubtful | Natative trouble Physical signs of obest No physical signs examined Not Total 13 0276 a9 b 0276 0276 3 oO 0276 " ro) At least # of these showed no evidence associated with sabertos 2 of these pot associated with usual signs found with asbestosis 6 of these not associated with usual signs of asbestosis What significance if any can be attached to the presence of asbestos corns on the hands of workers appears doubtful as 18 percent of the positives 12 out of 64 and 15 percent of the others doubtful 7 out of 37 negative 2 out of 20 showed such corns Each roentgenologist who reviewed the ray films called attention to the fact that these films indicated a very unusual incidence of enlargement of the heart It is probable that this is a compensatory enlargement due to the additional work put upon the heart in efforts - EFFECTS OF ASBESTOS DUST ON THE LUNGS 9 y to pump blood through the fibrosed lungs It is possible that not eal. sufficient attention has been paid to the effects of the pneumoconioses upon the heart Many workers had changed from one department to another and from one plant to another during their years of employment in the me asbestos industry Since only the amounts of dust collected at the time of this survey in the various departments are known there is no way of knowing the average amount of dust in the atmosphere inhaled by these people over the years of their employment Consequently it is not possible to correlate individual cases with definite amounts of dust exposure INBURANCE CLAIMS To throw light on the relationship between asbestosis and pulmonary tuberculosis an analysis of death claims and total and permanent disability claims was made in regard to companies carrying group insurance and having available figures There were 2,099 lives involved with a total exposure of 7,019 life- years The death claims are so small in number that reliable con- clusions cannot be reached from any subdivision of the figures same is true of the sickness claims under health insurance The The number of claims for respiratory diseases is high in two of the plants studied but low for the others as compared with the Metropolitan experience of 1927. However during the latter part of 1928 and the first part of 1929 there was an epidemic of influenza The records of one establishment plant B showed that 6 of 36 death claims and 8 of 10 permanent and total disability claims were listed as due to pulmonary tuberculosis This appeared to be an inordinate amount of tuberculosis from this plant However many of the employees were Negroes and also tuberculosis claims are generally high in this section of the country Realizing the difficulty in diagnosing pneumoconiosis and the tendency to confuse it with tuberculosis these claims were studied individually The physicians who had treated the individuals were interviewed and the hospital and sanatorium records including available ray films were investigated with the following results Death claims 1. A typist not exposed to dust died of pulmonary and intestinal tuberculosis 2. Colored male age 27 worked in asbestos 1 year and 8 months died of pulmonary tuberculosis following a hemorrhage . o was in sanatorium 10 months Also had a four plus Wasser- mann No evidence of asbestosis + 3. Colored male age 32 worked in asbestos plant 1 year and 7 months died of pulmonary tuberculosis after 1 month in hospital Cavitation both lungs no evidence of asbestosis - - ea . Se i OR eT eS teh: = geet : ~, a aw << 2' > 10 EFFECTS OF ASBESTOS DUST ON THE LUNGS 4. Colored male age 34 worked in asbestos plant 2 years and physician 6 months His believes this was a case of uncom- plicated tuberculosis Was not inmate of hospital or sanatorium No information could be obtained on the other two | cases Total and permanent disability claims . 1. Male employed in asbestos plant 3 years ; His physician states that he first came under his observation with an old estab- lished case of tuberculosis about 2 years after asbestos employ started Also bad tuberculosis of the kidney and cervical ment glands glands so ; 2. Male employed in asbestos plant 8 months His physician states finding of old fibroid tuberculosis with tubercle bacilli in sputum No ray available but according to physician as- bestos bodies were found in sputum 3. Male 10 years employment Two physicians who treated him at different times are now inclined to believe this man is not tuberculous but has asbestosis 4. White male was reexamined at time of investigation His physician reports well nourished busky looking good color no cyanosis no clubbing of fingers diminished expansion incessant cough ray shows fine mottling disseminated through both lungs No evidence of tuberculosis , Probably a second stage asbestosis right . 5. White male 13 years in asbestos plant Is now in sanato- rium An interesting case His physician states that he has ex- tensive asbestosis and pulmonary tuberculosis cavity in lung sputum loaded with tubercle bacilli and asbestos bodies believes tuberculosis long antedated asbestosis This patient is progressing in a satisfactory manner . It was not possible to locate the other three cases of total and permanent disability who had been diagnosed as having pulmonary tuberculosis On the basis of the information obtained the deaths in claims cases appear to be due to uncomplicated tuberculosis three of them were Negroes who were probably tuberculous at the time their employment in the asbestos plant commenced : - Of the 8 disability claim cases I was uncomplicated tuberculosis and 2 were uncomplicated asbestosis who were put on disability because of a mistaken diagnosis of tuberculosis In this same com- munity we know of one death due to uncomplicated asbestosis in an individual with many years employment in the industry CONCLUSIONS _ whole . fibrosis 1. Prolonged exposure to asbestos dust caused & pulmonary 3 of a type different from silicosis and demonstrable on ray films Clinically from this study it appears to be of a type milder than be .. 2. Cases of definite cardiac enlargement were frequently found to associated with asbestosis ene ee * Personal communication wee ve tad taeds : i arte 4 , > a a AINE Ga SPAN KE Ne ee al o 102: AY Shorix "y x a BT EFFECTS OF ASBESTOS DUST ON THE LUNGS 11 3. A predisposition to tuberculosis due to asbestos dust indicated in this study ' was not 4. Asbestosis as observed in this series of cases had not resulted in marked disability in any case . 5. It is not known how much asbestosis may add to the of pneumonia and acute mortality nontuberculous pulmonary infections 6. It is not practicable as yet to establish standards for the asbestos dust content of air 7. The amount of dust in the air in the asbestos be substantially reduced plants studied can RECOMMENDATIONS It is recommended 1. That the industry seriously face the problem of dust control in asbestos plants 2. That new employees be examined physically including ray examination of the chest and rejected for employment if they show tuberculosis or pneumoconiosis . 3. That employees be examined physically preferably but at least every 2 years this examination to every year include examination of the chest an ray 4. That the industry sponsor studies on known cases of as well as studies on effects of asbestosis on the heart and caisrbceulsattoisoins ACKNOWLEDGMENTS The authors wish to express their sincere thanks to all those who aided in making this study possible especially the officials and ployees of the asbestos companies who cooperated to the fullest em- and gave every facility for securing data also to Dr. extent Pancoast of the University of Pennsylvania for his interest and valuable advice in interpreting ray films and to Dr. F. V. Meriwether of the United States Public Health Service surgeon in charge of the United Bureau of Mines Cooperative Clinic in Picher Okla whose Sitnatteer-s pretation of all the ray films listed in this report is followed preciation is also expressed to Dr. W. Atmar Smith and Dr. ApKenneth Lynch of Charleston S. C. for information and advice particularly as to the pathology of asbestosis to Dr. W. W. Wild of Charleston S. C to Dr. Joseph H. Wyatt of Newark N. J. and Dr. H. H. Fellows of New York for assisting in interpreting ray films to " Dr. Paul O. Snoke of Lancaster Pa to Dr. R. H. Stevenson of Danville E. Quebec Canada and to Dr. L. U. Gardner and Mr. Donald Cummings of the Saranac Laboratory who have undertaken the study of the pathological effects of the inhalation of asbestos dust * ^ abertasisbodies in sputum and lung By Kenneth M. Lynch D. and W. tmuur Jour Am Med Assoc ug 30 1930 vol 86 no 9 680 861 8mith M. pp TES seh | cette 5 ; > asges an : o8. we rae th a pec <x, f Row Ca kinky Shee 87! ney oe 8 ee 2 2%.al oh Ag ern ve v= -Y ota A tre Veer Be OSStaO ae AR Ra pes re OOa bpeg AE mS t ACS ree 2; acs nT aS! arrest Bet SN EP toe aT page cag Sey pars wows 0 eke 5ses =, cas tet aCe Moree 12 EFFECTS OF ASBESTOS DUST ON THE LUNGS through animal experimentation with the aid of a grant from the Metropolitan Life Insurance Co. REFERENCES 1 Greenburg Leonard and Bloomfield J. J The impinger dust sampling apparatus as used by the United States Public Health Service Pub Health Rep vol 47 no 12 Mar. 18 1932. Reprint no 1528 2 Drinker Philip and Thomson Robert M Determination of suspensoids by alternating precipitators Jour Ind Hyg vol VII no 6 June 1925 3 Hillebrand W. F The analysis of silicate and carbonate rocks Bull 422 United States Geological Survey Washington D. C. 4 Cooke W. E Pulmonary asbestosis Brit Med Jour Dec. 3 1927 5 Green H A photomicrographic method for the determination of particle size of paint and rubber pigmenta Jour Franklin Institute 1921 pp 192 637 6 Whipple G. C Vital statistics John Wiley and Sons New York 1925 p 451 7 Russel A. E. Britten R. H. Thompson L. R. and Bloomfield J. .: The health of workers in dusty trades II Exposure to siliceous dust granite Industry Pub Health Bull No. 187. 1929 - -- ; SLES -5> kisSe owe a e pore gs Sr w Sy ete tiate Sets, re) Tes {edt e325? 2 He oe f t a af so PARES. nO STiar At ae re Feeta ocr ane Saaeee Se See 3 Pi ee. Bad ness: Nar Sept EROS ON Os a ae i ey: So Ataeheens : os gen v 7 ey