Document 5Dk100DE7Xw5D1OnmDzzQpVe

FILE NAME: Metropolitan Life (ML) DATE: 1933 DOC#: ML207 DOCUMENT DESCRIPTION: Dr. Lanza Answers "Verbatim" on Protective Measures at Johns-Manville Waukegan, IL Plant, Recommending Against Warnings to the Workers \ I /9S3 that such airline respirators were "on the market," he was fully aware that they cannot be worn except by a person who stands in one place as they have to be hooked up with a rubber tube to an air line. I doubt if they would be practical in a textile plant." 7 ''v Exhibit: " Q uestions A s k e d Dr. A. J. Lanza and His Answers V e r b a t i m , " forwarded b y S. W i l l i a m s to A. Fisher (August 29, 193.3). 3034. Asked whether the workers should be warned of the hazard in breathing asbestos dust, Lanza responded that no suc h w a r n i n g s should be given, "e s p e c i a l l y ... in v i e w of the extraordinary legal situation" (presumably a reference to the recently settled asbestosis suits). Exhibit.: "Questions A s k e d Dr. A. J. L anza and His Answers Verbatim,"'forwarded b y S. W i l l i a m s to A. Fisher (August 29, 1933). 3035. Asked whether employees diagnosed as having asbestosis would be removed from areas that produce dust, Lanza responded that it would depend on a number of factors: If he is well along in years and shows no disability, it may be just as well to leave him alone. One of the difficulties and vexations in trying to deal with the problem of pneumoconiosis is that economic as well as production factors must be balanced against the medical factors. Ill - 23 S: 0 />' % i (ini m*imrtg) *U|Hl tt| . A, lUkar, N iUl l u t a i fHBRXOM M O D UIU V i BooaanmcM or run mxsxojui mumm * T* % njNttM at M i tatatfMU Mil I Um M m if Oral m Im M m f * I . J. M l I if i t ; QUESTIONS ASKED DR. A. J. LANZA AND HIS ANSWERS VERBATUM Question No. 1. Among eleven employees in the Textile department, all exposed to asbestos dust, one only wears a respirator, several on being questioned claim they cannot wear them continuously especially in hot weather. Should all employees be forced to wear these respirators whether subjected to much or little asbestos dust? Is any such difficulty experienced at the Manville N.J. J-M plant or other places of which you have knowledge? Answer: Respirators are not satisfactory. It is possible to construct a respirator which will filter out fine dust, but it would offer so much resistance to respiration that it could not be worn continuously on an eight hour shift. There are on the market small face mask respirators which are equipped with positive pressure and these are both satisfactory, efficient, and comfortable but they cannot be worn except by a person who stands in one place as they have to be hooked up with a rubber tube to an air line. I doubt if they would be practical in a textile plant. Question No. 2. Do you agree with my recommendation that employees definitely be made aware of the fact that asbestos dust is hazardous to their health? My idea is that a poster be placed at one or more conspicuous places in the department, signed by the physician, stating that the dust is injurious, advising the continuous use of respirators while at work and cleansing of hands before eating lunch and after work. Your comment on this please and particularly is there any additional advice that should be given? Answer: This is partially answered by No. 1. I doubt if the hazard is sufficient to justify warning posters as might be used where lead, benzol or carbon monoxide are concerned. This is especially true in view of the extraordinary legal situation. If anything is said at all, /it would be better to make a general statement that the Company is taking steps to control the amount of dust in the air for general health purposes. Any action contemplated at Waukegan would probably be influenced by the experience at other plants of the Company. -2- Question No. 3. Do you regard the findihg of asbestosis bodies in the sputum as pathogenesis of asbestosis? I have one employee with x-ray and physical findings pointing toward asbestosis but not sufficiently definite that I can be positive as to whether or not she has asbestosis. However, every one of four or five specimens of sputum examined show typical asbestosis bodies. On the other hand, is it possible for a person to have asbestosis and not be able, with careful and thorough search to find asbestosis bodies in the sputum? Answer: The presence of asbestos bodies in the sputum only implies that the individual has been exposed to asbestos dust. I am not certain of the exact pathological significance. My impression is that the presence of asbestos bodies in the sputum indicate some definite lung pathology. I believe it''is quite possible for an individual to have asbestosis without asbestos bodies in the sputum. Question No. 4. Are you of the opinion that the added information derived from stereoscopic films of the chest justified the procedure of taking a stereo on every case that is to be x-rayed? This is the conclusion I draw from Dr. Pancost's talk in Chicago. Do you consider it advisable and practical that an x-ray film be taken of every employee in the Waukegan J. M. plant who is exposed to asbestos or silica dust? To date I have x-rayed only those cases suspected, from history or physical findings, of having asbestosis of other lung pathology. Answer: Stereoscopic films are better than single films. They are also more expensive. In our work at the Picher Clinic, we used single films simply on account of the expense involved. You can diagnose silicosis or any other form of pneumoconiosis from a single flat film. On the other hand, you can probably get a more complete and accurate idea of the -exact condition of any given case from a stereo. If it is the intention to determine what may be the extent of pneumoconiosis among employees, obviously the only thing to do is to x-ray all of them and then correlate your findings with the length of exposure and nature of the job in order that you may get a fairly accurate idea of what the hazard is. -3- Question No. 5. I have made a diagnosis' of asbestosis on an employee who has been working in the card room of the textile department six years. This place is extremely dusty. He is not disabled. In my judgment the best disposition of such a case is to remove him from the dust and give him a job in some other part'* of the plant. From your remarks in Chicago I believe this was your advise as to the disposition of such cases. Answer: It is difficult to answer this question. I think it would depend upon the man's age, the nature of his work, his length of service, and other considerations which might have some bearing. If he is well along in years and shows no disability, it may be just as well to leave him alone. One of the difficulties and vexations in trying to deal with the problems of pneumoconiosis is that economic as well as production factors must be balanced against the medical factors. Question No. 6. We have what seems to be an unfortunate situation existing in the fact that the asbestos textile department including looms, twisters, pools, etc. occupies one side or about half the width of a long building, the other side of which is occupied by the packing, brake lining and other departments in which there is very little dust. The card room, or most dusty part of the textile department is isolated by partition. Further isolation of the textile department involves considerable expense. Should or would you be guided by the dust counts and other observations in these adjoining departments? Answer: I think the answer to the situation outlined in this question is the control of dust in those processes that cause it. When everything possible has been done to accomplish this result, it may then be necessary to isolate or confine the dusty processes so as to avoid needless exposure or other employees not concerned in these processes. This is a situation that occurs in many different types of industrial hazard. It calls for nothing more than the application of common sense to the problem. RECOMMENDATIONS OF PLANT PHYSICIAN FOLLOWING EXAMINATION OF EMPLOYEES IN TEXTILE DEPARTMENT AND COMMENT BY DR:' A. J. LANZA 1. The provision of the best type of dust collection and exhaust ventilation equipment. Comment: By all means. b 2. Personal respiratory protection of an adequate and approved type for every employee in this department. Comment: I do not know 3. Employees in the textile department should tactfully but definitely be made aware of the fact that work in asbestos dust is hazardous to their health. Every reasonable effort should be made to induce them to war respirators. They should be instructed in the necessity of thoroughly cleansing their hands before eating lunch and after work and provided with adequate facilities for doing this. Comment: I think this is out, at least''for the present. Personal cleanliness does not enter into this problem. 4. I advise rigid adherence to the factory manager's order that no employees we hired or rehired in this department without first being examined and approved by the plant physician and further that no employee be transferred to this department without first being approved by the physician. Comment: Absolutely correct. 5. I advise re-examination, as indicated, of all workers in asbestos dust and x-rays of any suspected cases. I consider the re examinations and the continued study of this hazard and its effects of more importance than the first examination. From this point of view, the study of some of these cases may be considered complete. Comment: Entirely correct, with the understanding that no examination without an x-ray is worth anything in dealing with Pneumoconiosis. 6. I request, if possible and approved by Mr. Williams, contact with some authority on asbestosis who has x-ray films showing the condition. This for the purpose of comparative study of our suspected cases. Comment: We can probably help you in this if your company is willing. 7. My rejection of Marie Lutenski, made at the time of first examination, stands. Comment: This is outside of my knowledge. 8. I have deferred rejection or classification of Dwain 0. Bell, first: because of the delicacy of the situation which might arise in connection with his case, and secondly: because it is generally believed that removal of a worker from the dust will not retard or affect the progress of the disease once it is established. Comment: Ditto. n I General Headquarters) August 29, 1933. Personal & Confidential Mr. A. R. Fisher, Manager, Manville Factory QUESTIONS ASKED CR. A. J. LANZA AND HIS ANSWERS VERBMUM Attached is copy made by Mr. Kottcanp's office of questions asked Dr. A. J. Lanza by our local physician at Waukegan and his answers? also the recanrendations by our plant physician. I would like to have you turn this over to semeone who could review this correspondence and then go over it ycurseIf and write ice your opinion of it. ' ... cc - Mr. J. P. Kottcanp Waukegan Factory S. A. WILLIAMS, Vice President QUESTIONS ASKED LR. A. J. LANZA AND HIS ANSWERS VERBATOH Question No.l. Among eleven employees in the Textile department, all exposed to asbestos dust, cne only wears a respirator, several on being questioned claim they cannot wear them continuously especially in hot weather. Should all enployees be forced to wear these respirators whether subjected to much or little asbestos dust? Is anyhsuch difficulty experienced at the Manyille N.J. J-M plant or other places ofjWrlch you have knowledge? Answer: Respirators, are not satisfactory. It is possible to construct a respirator which will filter out fine dust, but it would offer so much re sistance to respiration that it could not be worn continuously cn an eight" hour shift. Ihere are cn the market small face mask respirators which are equipped with positive pressure and these are both satisfactory, efficient, nd comfortable but they cannot be worn except by a person who stands in one ice as they have to be hooked up with a rubber tube to an air line. I Jbt if they would be practical in a textile plant. Questions No.2. Do you agree with ay recanxnendaticn that esployees definitely be made aware of the fact that asbestos dust is hazardous to their health? My idea is that a poster be placed at one or more conspicuous places in the de partment, signed by the physician, stating that the dust is injurious, ad vising the continuous use of respirators while at work and cleansing of hands before eating lunch and after work. Ycur nr* cn this please and particularly is there any addi tional advice that should be given? Answer: This is partially answered by No.l.' I doubt if the hazard is sufficient t o justify warning posters as might be used where lead, benzol or carbon monoxide are concerned. This is especially true in view of the extraordinary legal situation. "If anything is said at all, it would be better t o make a general statement that the ccnpany is taking steps to control the amount of dust in thi air for general health purposes. Any action contem plated at Waukegan woiild probably be influenced by the experience -at.other 'ants of the Ccnpany.1 J / d P( i 2- Question No.3. Do you regard the finding of asbestosis bodies in the sputum a s pathogenesis of asbest0 6 is? I have cne enployee with x-ray and physical findings pointing toward asbestos is but not sufficiently definite that I can be positive as to whether o r not she has asbestosis. However, every cne of four or five specianens of sputum examined shew typical asbestosis bodies. On the other hand, is it possible for a person to have asbestosis and not be able, with careful a n d thorough search to find asbestosis bodies in the sputum? Answer: a -- T h e presence of asbestos bodies in the sputum only implies that "the individual has been exposed to asbestos dust. I am not certain of the exact pathological significance. My iapressicn is that the presence of asbestos b odies in. the sputum indicate sore definite lung pathology. I be lieve it is quite possible for an individual to have asbestosis without asbestos bodies in the sputum. Question No. 4. Ar e you of the opinion that the added information derived from -Stereoscopic films of the chest justified the procedure of taking a stereo o n every case that is to be x-rayed? This is the conclusion I drew from Dr. Pancost's talk in Chicago. Do you consider it advisable and practical that an x-ray film be taken o f every employee in the Waukegan J.M plant who is exposed to asbestos o r silica dust? To date I have x-rayed only those cases suspected, frtxn history or physical findings, of having asbestosis of other lung pathology. Answer: Stereoscopic films are better than single films. They are also m o r e expensive. In our work at the Picher Clinic, we used single films simply cn account of the expense involved. You can diagnose silicosis or any other form of pneumoocnicsis frcfci a single flat film. On the other hand, you can probably get a more complete and accurate idea of the exact condition of any given case from a stereo. I f it is the intention to determine what-may be the extent of pneumpaoniejsis among employees, obviously the only thing to do is to x-ray all of them and then correlate your findings with the length of exposure and -vature of the job in order that you may get a fairly accurate idea of what e hazard is. jesticn Ito.5. J 1 have made a diagnosis of asbestosis on an employee who has been working in the card roam of the textile department six years. This place is extremely dusty. He.is not disabled. In-ay-j'rf^nent-the best disposi tion of such a case is to remove him frem the dust and give him a job in some other part of the plant. T ra a your remarks in Chicago I believe this was your advise as to th disposition of such cases; Answer: I t is difficult to answer this question. I think it would depend upon the'man's age, the hature of his work, his length of service, and other considerations which might have seme beefing. If he is well along in years and shows no disability, it nay ba^just as well to leave him alone. One o f .the difficulties and vexaitlichs in trying td dead with the problems o f jaTeunrxxrdosis is'that ecchcnvic as Well as production factors mist be balanced against the medical factors. Question No.6. - - ' ~ ' We have what seems to be an unfortunate situation existing in -the fact that the asbestos textile department including loans, twisters, oools, etc. occupies one side or about half the width of a long building, e other side of which is occupied by the packing, brake lining and other -apartments in which there is very little dust. The card roan, or most dusty part of the textile department is isolated by partition. Further isolation of the textile department involves considerable expense. Should or world you be guided by the dust counts and other observations in these adjoining departments? Answer: I think the answer to the situation outlined in this question is the control of dust in these processes that cause it. When everything possible has been dene to accomplish this result, it may then be necessary to isolate o r confine the dusty processes so as to avoid needless exposure of other employees not concerned in these processes. This is a situation that occurs in many different types of industrial hazard. It calls for nothing more than the application of a n urn sense to the problem. PBCp'KENDATICCCKS OF PLANT PHYSICIAN FOtlJDWING EXAMINATION OF EMPLOYEES IN TEXTILE EEPAKIMENr AND OCMMENT BY m. A. J. LANZA 1.. The jroyisicn of the .best type. c f . d u s t _ o ^ equipment. -- Carcnerrt: By all means. and exhaust ventilation 2. Personal respiratory protection of an adequate and approved type for every employee in this department. Comment; I do not knew. .................. 3. Employees in the textile department shoiil3t^ci>jdly but^definitely be '' . made aware of the fact that work in asbestos dust is hazardous to their health. Every reasonable effort should-be made to induce them to war respirators. They should be instructed in the necessity of thoroughly cleansing their hands before eating lunch and after WDrk and provided with adequate facilities for doing this. Carment: I think this is out, at least for the present. Personal cleanliness does not enter into this problem. 4. I advise rigid adherence to the factory manager's order that no enployees e hired or rehired in this department without first being examined and approved the plant physician and further that no employee be transferred to this departrrt without first being approved by the physician. Ccmer.t: Absolutely correct. 5. I advise re-examination, as indicated, of all workers in asbestos dust and x-rays of any suspected cases. I'consider the re-examinations and the continued study of this hazard and its effects of more inportance than the first examination. From this point of view, the study of sane of these cases may be considered carpiete Comment: Entirely correct , with the understanding that no examination without an x-ray is worth anything in dealing with Rneunxocmiosis. 6. I request, if passible and approved by Mr. Williams, contact with sane authority cn asbestos is who has x-ray films showing the condition. Uiis for the purpose of comparative study of our suspected cases. Ccrrment: We can probably help you in this if your carpany is willing. 7. H y rejection of Marie Lutenski, made at the time of first examination, stands. >, Comment: This is outside of ay knowledge. 8. I have deferred rejection or classification Of Dwairi 0. Bell, first: be cause of the delicacy of the situation which might arise in connection with his case and secondly; because it is generally believed that removal of a worker from the dust will not retard o r affect the progress of the disease once it is established. aranent: Ditto. t% /> ^s3Ul 3, U k , fttr. I, I, \ fconii* *m W u ft. /. U J U h l ( * W U ayr tM b %r Mr. I i U i i 1! CTlaa t f fLM M jau u m frr. i y - . 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