Document 50a0N998GnMMRXzZO30KZbD8z

FILE NAME: Uniroyal (UNIR) DATE: 1957-1958 DOC#: UNIR028 DOCUMENT DESCRIPTION: Report to US Rubber Cov Hogansville, GA - Preliminary Results on a 2 Year Study 1957-1958 REPORT TO ASBESTON DIVISION UNITED STATES RUBBER C O . HOGANSVILLE, G A . PRELIM IN ARY RESULTS on 2 YEAR STUDY 1957 - 19 JOHN G . V US, M.D NEWNAN, G A . ta lota 1956 and eariy 957 tavarol Informai maatingi mm hold with Mr. A .C . Link, Mr, John Almandar, and Mr. Jli Guy of the Hagantviii*, Goorgta U . S. Rubber Compeny regarding tho probi* of asbestos dhecet in tho Aabaaton Plant. If * t loomod that continuing effort* hod bn dtroctad toward* in* crotalngly eueeamM duet control tinea the piant*1 tacoption In 1942* to a point where duct count Information drowed tavoli in a ll divisione of tho plant generally well belew those recommended and occepted a* safe (veli In the aabeero* industry. Dust court! data, cellectad and eountad oeeordlng te occepted pr* eeduree, ot intervol ef every wonth or toro fra many ttaHent In a ll ram partienti of th plont were evcJlobls linee 1942, Check* by Indepcndent agonei*, ud a i th State ot Gergie Department of Health, The Induttrici Hyglene Foundation and th New York office of th U . S . Rubber Company, howwd geod corraiotton with th dota cellectad by th plent porsanno l. B ennuol cheet x-rayt hod been tokew on a ll worker end hed been read by a rodlalagle consuitent, wha eufamltted ht* repert lo th locai office of th company. X-nry wer taken ftam th begtantag of piani operstlon end offorod In alt ceeee a lacnographlc hletary tpamlng th occupationai tifa hlctary ef th worker. Catta of pulmonary athometti ware faoQlwttng to appear. By lata 1956, there wero five worker* with indisputable sign* of pulmonary disease though ta U due to ad o ttati*. On the basil of the foregoing Information aeveral recoonendatlon* were AM # 1. A cee^rwhemlve study ihowid be undertaken which vrowld attempt 9 Gvmiivv e . The worker* general health, and In particular,evidence of eulmonarv di*MM due ta aw aam ta mfemeoa dm b . Roentgenologie findings c . Dutf emmt accum ulative tnpoture dote mmaured in MfRCTY (M illion particles per cubic foot yean) 2 Conclusions should be fbrmufatad from thaw corralatione 3 , Recemmtndation* dsuld be erode to Insure protection of the arotktn from alertes duet? facilitate prdiction and early detection of rffctad vmrkerg and prepooe guides for further study. Compieta medical historic* were taken on each worker, with particular attention being paid to rtaplw tory and eortflovoacuiar eymmn*. Thorough physical ex amination* wero perforated, omitting only the breast and pelvic am ination* on fatal** 2. and rectal snalnotlgn on role* (In all co m patient were od^lwd to have their fondly doctors complete Hits port of this Nomination, tost subsequent negative reports to them fay mo lull thorn Into false physical security). Numorou* pertinent laboratory stu d * ore mod*. Those Included skin Hot* for tuborculo*]* (Tuberculin 1 1 1,000) and Mstoploemosis (Kittoplaenin 1 1 1,000), vital capacity msreurements, urinalyses, end eomplete hemograms. Hsmograns were ssmpceed of o white blood call count and differential examination, and determination of rad blood coll count, hemoglobin, and hematocrit. Sodheentotion rotes were obtained In oil cores. Where particular side abnormalities wore found, such as pus, blood, sugar or albunln In the urine, er abnecmel blood values discovered, tests were repeated, and If verified, patients ore referred to their fussily physician for bother diagnosis (If necessary) and treatment. Throe feur-fll* x-ray viewboxos were Installed In my office and serial roentgenograms (In some cases dating back to 1942) wore examined with particular in terest In the appearance ef advancing pattern of asbostre disease In those who have developed the disease, and In the x-ray-dlnleel correlation. O r. ftjgone Pandeigrem,. Chief of Radiology of the University of Penn sylvania Modiad School end x-ray consultant to the U . S . Rubbra Company, kindly spent o day with am at the outset of this study reviewing the radiologic pomibiliHes of pulmonary asbostre disease. Hit help was invaluable and facilitated this study to o con siderable degree. Dust count data compiled from 1942 through September 1957 were mode available. These date were obtained from analyses made by Mr. Jim Guy, Safety supervisor of the HegoneviUe asbestos plant of the U . S . Rubbra Company, and horn studies mode by the fnduolrief Hygiene Foundation of America in 1950 and the Institute ^ ef Industrial Medicine- New York University- Bellevue Medical Centra In 1954. According to the statistical analysis of January 1954 by the Institute of Industrial Modfelrre- Now York University- Bellevue Medical Center graphs were drawn detailing the ovarags monthly duet counts since 1942 In the various compartments of ths Hogmvilio Asbrelon Plant of the U . S . Rubbra Company. Du* counts vmr* uniformly high initially In ell comportments and highest In the following decreasing order opening and picking, east carding, weaving, spinning, flyer frames, and winding. Uniform downward trends of average monthly counts of asbratos Are (naitir~J In M ffCF) wore observed In all areas as dust control measures become more efficient. 3 totals. Monthly dot counts won than cvercgod out and shown as average yearly The maximum allowable conoontrarion of asfaotfot partklas of 3*10 micro siao has boon hold to bo 5,900,000 parricio* por aibie foot. This figure has boon hold to bo such that a worker, working o 40 hour week should bo obto to labor o llfotlmo at this expos** without developing asbestos disease. Thore is no door cut origin of this figure and It may bo that It Is simply a cony over font tho figure hold to bo sofa for tho silicon Industrie*. Utfng this figure os a basis, Tho NtwYork-Bollsvue group formed charts which showed the following Winding More than 5 MPPCF 1942-1944 Um than 5 MPPCF 1945-1953 F l r Frames More than 5 MPPCF 1942-1946 Lore than 5 MPPCF 1947-1953 Spinning More than 5 MPPCF 1942-1946 5MPPCF In 1947-49, le * than 5 MPPCF 1950-1953 Weaving More thmt 5 MPPCF 1942-1951 Loss tfot 5 MPPCF 1952-1953 g. Carding More than 5 MPPCF 1742-1949 Loss than 5 MPPCF 1950-1953 Ooanlno and m $S More than 5 MPPCF 1942-1950 Urn than5M PPa 1951-1953 Tho total oceumutatlva axposuree In oach area has boon loop In winding and incrementally increawd through opening and picking whore the great average oscpawro has boon and stltl adds* Continuing dust data nawshows the following figures through September 1957 Winding 2.0-2.9 MPPCF- deponing on location (Most stations avorogo around 2.7] Flyer Frwnosi 2.0- 2.6 MPPCF- depending on location (Most stations avorogo around 2.6] Spinning 3.0- 4.0 MPPCF- depending on location (Most sto'bro avorag around 4.0! Weaving 2.0- 3.3 MPPCF- depending on location (Mo* rtatlore avorogo around 2.2 2.7-37 MPPCF- depending on location (Most stotlons average around 3.( Opening and Picking 3 .0-3.7 MPPCF- depending an location (Most stations avorogo around 3.2 4. On fondred thirty-four worker-potlwm wero examined in 1957. fo rty nine -me* white males, and ovontyfaw war* white feawi. Eight wars colored male end three were calorad fomoie*. One hundrad twelve workar-potkeitM war cxninad tn 1958. O f thora, on* hundrad Mran hod been previously examined In 1957 and fiva war aathad up for the fim time to 1953. aan in 1957 but not re-examined In 1958 hod laft tha company or war an leave of obMnca. Over tha 1957-1953 pan ona hundrad forty-eight paopla war indudad tn thH ludy. Nfoa haw* not baan examined but hova been indudad in tha rtudy bacouaa thalr x-ray and duet count data art available for anamination. Five ora now worker and four am potion** with daflnit* and known pulmonary aifaatio], who hod boon returned or trqrwfarrad eltewhera before tha atydy began. Thaaa indivlduoiaora t , and- Worker* war divided by year* of occmeuiartve expoaure in tha following awamoc with tha fallowing flndlngi. No attempt wo* made to aporota different fob domificotieni In tHU Mfiaa* 0-5 Fortylavan workan ranging Irani 2 month* 1 five yoon tn Aabatton and with total oeeuauietfve axpoaura ranging from 0 .3 - 2.0 MPPCfY. No avidanca of odboataa pulmonary dimaa wo* found. Several other aondlHom ware uncovered- Twa potianta with dtobataa m elllh*, ana with probable congenital ehetellthiotie, ana with rhawaoHc heart dbeoM, and three with pulnonary hyportondon auapoctod on boat* of laud aacond pulmonic eund) and Mvoral with rathor oavoro onamlo ueueliy dua ta nanonrhagia and tnaaaguata diet* Twa patient with mentlol hyperteniien ware & *- avarad and traotnont m eit--indad ar oneourogad. Of thaM forty van, twenty two wort while molan twenty-two ware white fomoiatt twa war eaforad molaaj ond ena wot a colored female. One woe from opening and packing; twelve ham carding) fiva from Ayer frame; four ham winding; nine from pirating; ond thirteen from weaving. One patient, 43 WM from Weaving with accumulative axpaure of 4 MPPCFY hoe hoot x-ray which 1probably normal but which dtowa mWtimol euaplaiou tigrw* 4-3 Thirty-five worker rar^tr from 5.3 to 8 yean In aibearon and with total accumulative expaoira ranging from 13.2 to 47.9 M ffCFY. Ona patient, ,, 52 CM of opening end picking with 7 year and 47.9 M9PCFY deflntte evidence of pulmonary odmataai. Five patient hove equivocal but rrjQM tht early avidanca of pulmonary akwatoait. Ihaaa ora 39 WM of winding with 4.5 year* ond 22.4 MP9CFY; 32 WF with 8 year* raid 25.4 MPPCFY; LoU Hum, 44 Wf of winding with 7.0 year* ond 21.8 MPPCFY; , 35 WM of winding with 8 yearn and 35.4 hW CFY) and. , 34 WF of pinning with 6 yera*and 24 M PfCFY. '* Is ttnlt*. Th* oihar five must ba mpordod with uepleton, and watched closely. 9-10 veert ~' 5. S*v**ot oth* conditions wera found Nino patients ( six from winding, Km>from pinning, and on from flyer from) had histories of reeunent sinuso-trechoo-bronchitis. Only on, ihowod arty xmpicion of pdawrw y asbestos disease. Two patients with hyportonsiv cordiovoocvlar dtaooM and on with byportomlvo vascular disease woro found; on with non-toxic nodular goiter; an with low grad chronic urinary tract infection; <nd thro with moderately severe anemia (M ow 10,0 gram %) were found, Patients war Informed and advised in ail inttanem to oorault their femlly physicians. O f thece thirty-five, tan want whit alee; twenty-three were white fsscd ssj two were eelarod malec* Two were from opening and picking; two from carding; lx from flyer from; Rve from griming; eighteen from winding; one from weaving. On patient with definite early aabeateel 1from opening end picking. O f thece with suspicious ilgn one each t feom weaving, flyer from , winding, and griming. Twelve workers ranging from 8.5* 10.0 years In asbeston with total accumulative snpooure ranging from 29.4 to 74.9 MPPCFY. One patient, _ .. _____ ,, cerder, 81 WM with 10 years and eccumulatfve exposure of 38.0 MPPCFY hm definite early redidogle evidence of pulmonary rahsetsili. One ether, ., 41 CM of opening and picking with ? yean and 54.1 MPPCFY total accumulative exposure has shown equivocal early rodfetegte signs ef pulmonary ubestosls together with decreesing vital capacity and rising rad blood cel) count during the pad year. Other conditions found included two with recurrent bronchitis end bronchiolitis but with ns evidence of admdosis two with asymptomatic hypertensive cerdlovaeculor dheami and one with essential hypertension; two patients differed with recurrent urinary tract Infections end one gov* a history of peptic ulcer with hemorrhage. Those patients were appraised ef their conditions and advised to consult their femlly physicians for further cor O f thorn twelve workers four are white males, seven ore white femdes, end one Is a colored sale. One U freer opening and picking, one from cording, three from fly * frames, one from spinning, two from winding and four are fromweaving. The patient with definite cebestosis Is horn carding; the one with equivocal early changes W from opening and picking. 6. 11*12 yww TVnr ere twenty arm worker with 11-12 year experience wtfh tutd eeuemiotlva <faeee racing from 36.0 to 118.5 MPPCFY. O f Wogrew? only even preeent no rsdblogie evidence of puimonmy Bebeateala and three of theee even mm bo regarded with enpldon bo* m m o f Increasing red blood cell value, acriy 1ubblng, or changing fa m ily of tho eecond pulmonic heart aged. O f the ramdining fourteen, eight have unequivocal- end in eeverel came kern ed com of pulmonary o iw U e li# four hove equivocal eorly changee and two have m inim i and queetienofala early sfgm . Sia of thl group have previowdy beco diecuvw d end tromfmrrod te other mettane of th Hogonmiile Pieni. Ihefn oro th meet odvanced ceew. They ore . . 4 5 wM woauarwtfh 12yeoand58.2MPPCPY; , 45 WM eeinder end fly freme tender rlth 11 yeert end 56,0 MPPCfY; . , 5 4 WM w tth tty em en d 2 .6 MPPCFY; , Wf *M m rw fth l i yeenond 18.5 MPPCFY/ . Wf weever wlth 13 yeers end 100 MPPCFY; end , Wf tpfamr wlth 12 yeere end 72.2 MPPCFY. O f the remaining eight, . w, 3P Wf weaver, hae 11 yeereond 56.6 MflPCFYand'. ., 42 WM winding and weaving tupervieor, Ime i l yean end 41.5 MPfCFY. O f the early equivocal patient, . 52Wf weaver, he 12 yem and 79.8 MPPCFYj " 47 CM opener end picker, hae 11 yam ond 81.7 MPfCFY# , 48 Wf winder, hae 12yarn and 42 MfPCTY) end ,4 $ WM evewaor In cording and epfating M 12 yem and 51.2 MPPCFY. The mere equivocal, hut early onpfalnue portent Include 42 WF fly frame tender with 12 y a m end 42*3 MPPCFY and 52 WM eminent ovareaar in carding and rpfaning, 12 year and 51 -2 /rfPPCFY. O f the fetal group few unrelated madkal cancArtanewero recovered. One patient had eeymptematic hypertenetve eardteveaeuier dfaoeej one ruffe with recurrent bronchitie (but hoe no evidence of nebeetneie), one hae aethre emeu)dering rheummel d orthritU# end one hae had renal ed cu ll rlnae being fMwriQ n w vns rM V fti nonr* O f the iwonty one worker, eight are white moie; twelve are white femaieej and one ie a colored ami. 7 On i from opttvlng and picking; three or from carding four are fly frame tandem; four a n from sinning; Four from winding} five fnm weaving} bur o n bt tuptrVitory eapocitUw. O f Hot eight patient with definite esfcactoali two art ftta winding} an from w a v ing} three from spinning} on from cording; on it a uporvbar 1 waving and winding. O f the other tig on fit opening nd pickin * on i t fly h a m tender; atm from winding} on fra waving; end! two art In ovaneetng eepotlH* in caraRng and iptnnlrg. 13-14 y tm There ere fourteen worker* ranging from 12.5-14 ytari In atatfen and with accumulative arepeture from 41,4 to 125.4 MFPCFY. Of thit group seven appear free of th* <flteace. Of the reawtning tevan, WF pinner with 13 year* end 123,4 MFPCFY, haa been previously trentforred. Two others dww unequlvwed Ifni of pulmonary odb--rarii, They at* . , 34 WM cardw with 13 y. yean end 74.0 MFPCFY and . _ . , 33 rtf primer with 12.5 yean and 42. t MFPCFY. Four hev agrfvoed oily chongot. Thay art ^ . * 47 * F weaver with 13.0 yen and 41.4 >tffCFY; 51 V/F f m tender with 13.9 yarn and 34.7 MFPCFY; , 43 Wf from tandar with 14.0 yam and 74.4 MPFCFYj and , 42 WM waving wpervlaor with 14.9 yaan and 112.4 MPFCTY. Other eondlHam found toddad t w with chronic and recurrent faranchllU; oat of whom hat early auepioloue cdbeetotit, am with lag rein thromhe- phlobltl* and tutpretrf n a t t M fadl; on with oout glcoare- tonephrltlt, om with virgin dlahatw meillhi, and on with hypertensive eenfiewotewler disease. O f that* faurtoan, four a n whit a d at; tan a rt white females} four or fran spinning; <* from wlncBng; ana fn** waving; and on# 1*an efflee secretary. Thar It an overseer from waving end winding, 144* year Thar arenineteen worker in thlagrewprangingfare 14.3to 14yaw and with accumulative atpotun f m 32*3 to 173.9 Mt'PCFY. O f thlt group, tight or* fra of tha dtaoaa although one hot egdvocel dubbing of finger noil. O f tha remaining ievtn, t w have dready boon removed from tha asbnton plant. They ore ,3 9 WM spinner and supervisor with 13 yaan <md 173 MFPCFY m i 43 WM e e rie r with 13.5 yaan and 98.4 MFPCFY. Of the remaining nine, bur Hava uneqtihrecel aorly pulmonary dretttd*. Thy a n . , 54 WF winder with 13.9 y a tn and 5 3 .4 MTPCFY; , M vF with 13 y*w* <md 101.4 MPPCFYj ' _ 44 CM from opening and picking with 13 yaan and 128.6 MPFCFY (hot been ramavad from whswnri)} wd 8. , 32 WMepinner with i5 yaw and 83*8 MPPCFY. Flv othew with oariy Mptcious changes or* , 43 7YF with 15 yaw and 63.5 MPPCFYj ., 41 Wf winder with 15 yaw and 52.5 MFFCFy; , 40 WM confer with 16 yean and 71 MPPCFY; 57 CF weaver end swappar with 15 yean and 101.4 MPPCFY; and , 38 WM pinner with 15 y a w and 83.8 MPfCFY. Other ntadlcd conditions bund induda ana patient with chronic bronchitfe; bur with hypertensive cordloveeculor dieeoM and two with eeoentiai hypertension; on* with severe anemia; and an* with intermittent daudkatfen daa t* peripheral ertoriood orosis. O f the twenty-one patients, eight are white males; seven are white females; two are colored males; and two are colored bmalee. In eummatlen; ef enehundred forty eight parlanti, ntnetaen pattanti bave definite end unequivacai aarly te edveneed pulironary rwbeWaiii; slxteen hsry equivocai eariy avidenee ef th d im m i end four bave dightiy sue* piolo changes. A tota) of thlrtynine In o li. O f theee fhtffynine, four ere from opinine end pldclng; four are tram eardine; four are front ftyer M stew; ten frem qpinning; seven frani winding; and fiv# ano fraat weoving. Two are In o/parvtory capacittas in ardine and plnnlng; two In winding end woavlng; and erte in confine and fiy. Chart f 1 dwwe a diitributton at yatfon with varying degrees of ac* oMulatad exposure. Thera ora two patients with ? 4* changes with 21.8 yarns end 24.0 MPPCFY; andtwo with 22.4 yaw and 25.6 MPPCFY; ana potior* with one 4 changes at 38 MPPCF; ana with ? 4 change at 42 MPPCF; and two with' 4 changes at 41 and 42 MPPCFY. There is ana with one changes aT47.9 MPPCFY. The remainder begin to buneh at 5C million particles par cubic foot y aw and show no particular does severity raiatiomhlp until 70 MPPOTY is exceeded. Even hire one is t two are ana ; one is two *|*; and four are three -j- . Meet ef these from winding and opening and pieking who how Involvement do ee before they have e total occunulate axpeourt of 60 MPPCFY. Weaving, spiraling, earin g , and fty r frames tendms are Drawn out In random frahien from an accumulative exposure ef 60 MPPCFY on. I "S / 9. M illion Partld-- 9 * Cubic foot V eo* (MPPCfYl CHART * 1 -P B --------- "S P G i r a ; --------- 4W K T ~ 3 p h -- -- H ETTSw " 24.0 S T 5 f f ----------- 1 0 T JT " r S fjR T " 25.AFF 1357----------41WE 4 1 .5 w t AW 4 ?A 6 p 51-3 C AS 34-OP 58 OP 54.7 FF 52.5 W Z537F 1"' 43T5 7Th65------ -- g r ^ T " -- S P R S T " 1 T fjT w i 83.8 S 71 C 74.4 S 40 S + 3 W 5T ^8.6 C i+ 58 W 2 JH ~7 0 1 54C AFF 4 ra z n W T.4 wE M2 WE A w 101.4 Wf 128 OP 118 S I3STs ioo w 125 S OP C FF$ W WE - Opening end Picking Cording Flyer Frame Spinning Winding Wetvino 10. T taa ora 4 pattati wlth 3 - oabaatoili. Thay ara at folio -Colijan 1 (Soot. 1957) Coiumn II Coiumn MI .<$) 138.7 (FP& C) 54.0 ($) L ll* .t a . 1950 Jan. 1953 Jan. 1955 110.7 MPPCFY 44,0 MPPCFY (tf) 100 (w) a . 2 t a r . 1949 Sopt. 1956 45.0 MPPCFY 53.3 MPPCFY <S> 125.4 7 tarta* of th*lr **rcy* dioua t t a definita 1 + chango occunad o notad undar Calvin I I . Tholr total accumulettva axpoaoa oorractad to tha timo of fin roontgmoloie chongo k Hitad undar C oiumn III. A con bf raadlly oborvod; tfvaa of thow parianti continuad ot rta lar ovara! yaraioftor fin daflntta Igra af tha <fiooaa and amanad rotta igpMIy. Two pattati ron datactad fatrly rooondy, yat fcy foo timo of rotavo! 2 and \ yaan (atar had ihomn rapW pragra rion t i tho pulmonar? Io t a , doglta loor continuas axpoaura rato faraught bout bjr Impravamenl of plant flltorlng and ax ta a t proaction. T ta a oro 2 pattato witb 2 * f adraotaait. Thay <* oo follavo Caloo 1(Soot. 1937) Calman II Cotimm III 74.0 C Jan. 1954 48.0 MPPCFY . 98.4 C Aug. 1934 84.4 MPPCFY 53.4 W Jan. 1957 50.7 MPPCFY* AH portato wlth 1 f or + pulmonar? atbacfcxll tara bagun to davolop pulmonory ondear ci ltica! hometalegic chongo wlthln tha pem yoar. 1!. TT _ Oiwu*I on and Conclusion Pulmonary rnhettaii Is a disease of the lung caused by exposure to and Inhalation of partial of aAcstoe dutf. The particulate size 1 important and probably varies from 3 to 10 microns. The finding that patlant* In tho winding action tond to de velop pulmonary tip at lawar accumulated exposure rat than workers In other section* (the tots) gross exposure rat being roughly equivalent) suggett thot the dust site ot the winding fattens may bo different or porhape that the velocity of eeettered duct may be greater with resultant greeter pulmonary penetration Mteroccoplc studies elsewhere have Aown that the anatomic change In tha lung constat chiefly of perlvoscwlar fibre!* interstitial fibrosis and thickening and widening of the alveolar capillary barrier There it additionally 9 marked plewrol and pericardial flfaretic reaction. The dinicai course of observed patients with pulmonary oibectosis hoe been Ineideout and marked by slowly progreeeive iaes of strength pep and energy and sente of welt being* Patients tend to develop a dry hocking usually non-productive, cough with amociated sticky pains acre the lower areas of tiw chut both anteriorly, poetorieriy, and in the axillae. Breathing ability becomes markedly diminished, but usually se dowly that patients almost automatically adfust to It and usually comment that their wind is ade quate If they don't hurry or strain. There hove been no Instances of evert right tided heart failure due to Increasing pulmonary blood preure. In several InWancas, patients have complained mast prominently of In digestion and epigastric and hypoehorvdrai discomfort, sub-sternal burning and frequent eructation, but without nausea or vomiting. There have been no Instances of pulmonary hemorrhage or gmotonaous pneumothorax. Sevsrd patients show varying degrees of dorsal kyphosis and/or kyphe-seolloslt. Others shew varying degress of pectus excavatum. These anatomleol chest changes have so far A men ne relationship to the Individual workers1 susceptibility to pulmonary oAestosis. So far there have been no suspected or proven cam of pulmonary tuberculosis or brarschogntc carcinoma either in the workers with oAestosis or In these with no evidence of the disease. There Is e relatively high Incidence of patients with various combination of slnure-phoryngo-trocheo-bronthlo-bronchioUtts. These patients have not 10 far shown any evidence of increased susceptibility to asbastos diseau. 12, On the b|ectfve tide ail patients with unequivocal pulmonary admctoi have shevm varying degrees of radiographic changes, (Sn U Iow,) These hove occurred at widely vwrytno total occuwulertve du doses and Ii m ne il(pilflcant relationship to apt, sax, of race. (However, rha high colored com rate I* reiotod in oil probability to the higher duet exposure rate or their particular jobs.) A ll patient with pulmonary rabestosli how slgnincanrty cflminlshsd vttd capo (fa*m trad roughly by McKesson-Scoff Vital Capacity Apparatus). No attempt hoc been made thue fm to eeoure timed vital capacities spirogram, maximol breathing copocUi*, diffusion rates, or oxygen and carbon dioxide ptemum aid saturation.fades. Many patient with pulmonary adbostosls heve developed varying degree of clubbing, the extent of which bear no significant relationship to the extent of the x-ray changes. in fact. In a few workers auspicious early signs of clubbing hove occurred without sl^ntrl s^rsy hm^si, While dubbing may occur congenitally aid Under a variety of other clinical condition It must here certainly be regarded a a suapleiou sign end the patient watched mare closely. Sooner or later, tn parlants with radiographie changes of asbsrtesli, ouscuifotory signe of pulmonary hypertension develops that ie to say, the second pulmonic and Inawaeed in intensity end ultimately becomes louder thon tic second aortic sound. In snma Instances this finding has (and/or is) occurred without as yet parallel radiographie changes. As noted above ne patient he as yet developed sufficiently severe or protracted pulmonary hypertension to manifest signs of right skied hesrt failure; aid electrocardiogram have thue far bean significantly innocant of changes suggesting right sided heart strain and/or Thsra tends to be e parallel rise In rad blood call, hematocrit, and hemo globin values with development of a moderate secondary poly cythemlo. Red coll counts may rim to 6.5 million par emm.j hematocrits to 52-54 volumes %; and hemoglobin from 16-13 gram per cent. With progression of tim lung disease these vdum tend to return towards end in some Instances go below nonee l, Radiograph! changes observed through the study of serial x-rays on thirtynine patients with carteIn or suspected pulmonary esbrntotls hows drown the dUaara to bo typified fay progressive chorees Involving th> lower lung vascular and IntorsHtlel strwchres with progressive diminution In lung volume os suggested by decrease In vertical cDwemlan* of the lung fields and Involvement of the pleuropericardial surfaces with eventual obliteration ef the cestophranlc and cerdtophranlc sinuses. Usually as tits picture develops emfhyswjvrto changes bagln to appear in the upper lung fields. The earl loot changes Involve either the serous surfaces or blood vernal* and ore marked by a funinem or hoggins* of the plewopericordta! outlines; or by an oppearwree of thickening haxlncn and nodularity of the vracular outline in the lower lung field. Neither lung seems to be predanirately selected and the Involvement may be either medial or lateral. 13. At about the tan* tin, and >n ton Imrance* van before, there begin* ta be a decrease lr>vrtical lung dfmemlon* (os measured front the f)rt castaehondral juncture to a I in extended from the highest point on the diaphragm. ThereofNr the change Involve progromivo thickening of the vascular dvsdov with eventual coalescence; proy lve thickening and irregularity of the pleuropericardial outline; and progrexive diminution in the total lung volume a* suggetfed by decreose in apicoi-dlaphrapinattc distance. For the purpose of this tfudy the following categorical claxifieatlan wot ettabllshsd; 0 No evidence of diseaee i > -- Equivocal change suggesting one f but Inefficient for ~ definite statement 1' -f initial furring or shocsirwes of pleural' or pericardial surfaces or Initial thickening and hoxinott of voecular outline* 2 + Combination of voecular and pleuroperIcordial change* with poc*ible early decreaee in vertical cheer dimension 3 f Change previously noted plu* development of background reticulation or ground qIq oppeoroncc In lower lung field*, coalescence of vascular pattern, further thickening of pleura* pericardial outline and greater decreose In vertical dimemtan* of chett. 4 f Almotf solid appearance of one or both lower lung field* plu* ail of above changes Nineteen patients were classified at hovli* definite pulmonary otbeetosis. AU nineteen have definite and unequivocal radiographic change campetlbi with the criteria previously ettebllthsd. (See pog 13.) O f theee nineteen, fifteen have been personally seen In thf ttudy. O f theee fifteen ell have diminished vital capacities and twelve of the fifteen dww decreasing vital eapaeiti. Similarly twelve draw tame evidence of High or rising red blood cell values. light of the fifteen patient* thaw varying degree* of clubbing and eight shew evidences of increasing pulmonary blood prenuro. Twenty patient* hove plue-minu radiographic change* according to the criteria established In this itudy. Sixteen of these patients dmw decreasing vita) capacity measurements, thirteen show rising ted Mood cell value*, four reveal Increasing intensity of the second pulmonic sound; and one dww* definite early clubbing. M. A definite diagnosis of pulmonary asbestos!* cannot be mod, under the condition* of this study* without radiographic changes. However# the appearance of ony combination of decreasing vital capacity, rising red blood ceil value, increasingly loud socond pulmonic heart sound or dubbing should be considered a suspicious sign in eny asbestos worker; ondt hot worker should henceforth be watched closely for further pulmonary asbostosis evidence That workenfr am any area within the Asbetion plant can develop pulmonary asbestos! It abundantly dear. Chart * 2 (page 15) shows a break down of workers bysections dotted against yean ofeeployment In boston. This chart suggests that workers In opening and picking are at greatest risk, 44% of nine workers having developed either definite or suspicious signs of asbestost. Chert f I suggests maroverth at these workers are apt to deveioc signs of asbsttosis at a lower totd accumulative dosage than employees in other divisions of tta plant. Employ ee from SPINNING are nest most frequently Involved. Forty-two % of twenty sis workers have definite or suspicious signs and twenty-seven percent have dsflnlta nsbsstosls inspection of Chart * ) * however shows that all seven workers with definite disease have a total accumuiatlved oee of over 60 MPPCFY; and that ail but one with suspected dtssaee has on accumulative exposure of over 50 MPPCFY. Employ e s from CAUMNG ore third meet frequently involved percentage wise. Twe are carders with over 70 and over 90 MPPCFY totd dose ond one Is fly frame cording supervisor. One patient, however* has on occsenuletive dose of only 33 MPPCFY. The relatively se d l number of workers from the carding section with esbaetosls may well relate to the fact that this papulation is young In regard to working years and total accumula tive doeege. Twenty four percent of thirty-four workers from Y1NDING hove definite or suspicious evidence of pulmonary asbestosIs. Fear cm definite end four are suspect. O f interest hare however* Is the fact that six of these eight (three from each group) have developed signs at somewhat lower tote) exposure doass than comparable individuals in other sections Yearly dust studies (See page 3) show the winding section to have one of the best dust control systems In the plant. These date raise a poosibllity that the charac teristics of the dust In this section ( e.g . else* velocity) may have a bearing on making the winding section somewhat more hasardous. WEAVING is next with twenty-three percent of twenty-nine workers. How ever fifteen workers h a y been on the |eb less than five years. There it e wide read In total accumulative doses in Involved patients In this section ranging from 40 MPPCFY to over 130 Mi lo ' an 05 A *8 9 -JO 11-12 13- 14 Cvor 14 Total* 15. Ntfubsf of Worfcor* 8Y COMPARTMENT S p ----------- C -- Ff l w Mi 2 12 5 2 2 6 1 1 3 9 4 15 5 18 1 1 3 3 1 2 5 4 4 5 1 2 3 4 2 1 2 4 2 3 3 4 9 23 24 26 34 2? CH<\RT * 2 Syparyitor ond Socrotary 0 T o ta l 47 1 35 0 12 0 21 1 14 J 1 19 3 148 Nuabor with Aabntost* 2 3 1 7 4 2 0 19 * Wortai* 22% 13% 4% 27% 12% 8% 0 Nuaoor with Smpoctad Atbattatl . 2 3 3 4 4 4 0 20 % of Work with Suapoctod AAostaal* 22% 13% 13% 15% 12% 17% 0 Nuaoor of Wortton with pealtivo or Mpoetod Aabaataal* 4 6 4 11 8 6 0 39 % of Worker* with pealttve or uapoctod A*ba*to*l* 44% 24% 17% 42% 24% 23% 0 \6. Only four of twenty-four F lY FRAME TENDERS have any evidence of osbeetoeii However, all of these show sign of the dtMuse at total doot under 70 MPPCFY and two of than aio under 45 MPPCFY. This action hoi ona of the bait records in regard to durf control.'The evidence would suggest however, that those work Who will develop " t * ' lo this lection will tend to do 10 earlier than in matt athor sections. 17. COMMENDATIONS Pulmonary ostatosi H an Industrial health and preventive medicine problem of the first magnitud. This study suggasts that ths primary and most Important factor In acquiring ths dissoas is ths individual worker' total accumulative txposun to asbestos dut. Previous safe level figuras of 5 MPPCf per year must be revirad radically downward; the only concession short of on ideal aero exposure being the mini max relationship of dtelnhhlng returns venarincreaeing effortbhd expense. An active program of education of the workers should be undertaken to alert them net oniy^oibendasspritdMW to the company's effort towards eliminating the ostato dust exposure haxord and early detection of affected workers. This program rfwuld bs energetic forthright and continuous. It should include not only the asbestos workers but their famiIles the remainder of the working body of the tfoganraille plant, and the community os a whole. Accumulative dust exposure figures should be kept currant and readily available an oil workers* Consideration should be given to posting section figures, by the month, In the Involved areas end Inviting workers' suggestions regarding methods of lowering the dust haxord. (One who Is an the dotty {ob may have some pretty good practical ideas.) Chest x-rays should be token* as Is now customvy/sn ell new workers and on worker* returning from layoffs, Illnesses, and leaves of abesoce. Otherwise x-rays need only be token at twelve.Intervals until the worker has reached a total accumulative dora of 30 MPPCFY. Thereafter, (above 20 MPPCFY) cheat x-rays should be token every 6 Clinical evaluation should be done during the first, third, and fifth years of the worker's employment; and thereafter , every year. It would be of great Interest and value If mere extensive studies could be undertaken regarding the nature end d s y e of Incapacity of these patients with demon strated or suspected asbestos!. The Information acquired would be of both medical and medico-legal significance. If the information we now possess Is properly utilized, no worker need ever pre y ss beyond minimal early changes of asbratoeis before he is detected and re moved to a loss hazardous environment. 18. If the yearly accumulative exposure do ! progressively lowered, It should nwan that a given worker will b abl to stay on the job much longer and at I risk to oil concerned. 4 P