Document 8Vx6yJRZDBywQEz6zLwrjBg2a

FILE NAME Brakes BRK DATE 1935 Jan 4 DOC BRK004 DOCUMENT DESCRIPTION Public Health Report - Effects of the Inhalation of Asbestos Dust on the Lungs of Asbestos Workers Medical lel ae] SIGH l we ch lch lch - PUBLIC HEALTH REPORTS VOL. 50 JANUARY 1935 1935 NO. 1 EFFECTS OF THE THE LUNGISNHAASBESLTOSAATSIBOENSTASBOESTOSS WORKERS DUST ON WORKERS ; Preliminary Preliminary Study By A. J. LANZA Assistant ant Medical Medical FEHNEL Chemist , Insurance Co. Director and WILLIAM WILLIAM FEHNEL ChemiztM,etMreotproolpiotlaintanLiLfifee INTRODUCTION Metropolitan In 1929 the officials asbestos industry United United were representing desirous of the asbestos asbestos asbestos dust States was occupa- by tional hazard in establishments establishments so what who of this their should to prevent the nature nature hazard and several articles articles prevent or control it medical had appeared appeared English medical medical coniosis had been quite uninformed appeared occupational disease disease uninformed existence existence any itself uninformed of reference reference lungs occupational silica with reference lungs has The been appreciated appreciated and great deal str and long been applied problem problem certain other other the been industries in Great the metal m st Britain , the United British Do- minions and the dust expressed other countries countries of nature the expressed in term silicosis tuberculosis effects silica resultant extraor- extraor- dust predisposition predisposition predisposition to tuberculosis is well known known These effects been pulmonary tuberculosis inhalation inhalation con- associated taining taining silica in varying effects upon upon pul- monary monary tissue of amounts combined silica silicates silicates ^' still fertile dusts investigation evidence accumulating are ae: Still certain certain thesefielddustfs or investigation pathological accumulating accumulating that produce distinct aA true silicosis silicosis asbestosis asbestosis pathological pathological is pneumoconiosis pneumoconiosis true The been applied the pneumoconiosis pneumoconiosis caused caused asbestos commerce commerce hydrated hydrated magnesium ically ically asbestos primarily of silica silica combined magnesium consisting consisting combined combined silica 44.1 primarily primarily water 12.9 percent mag- nesia percent in small a percent ferrous variety Nesia nickel quantities This commercial are present water 12.9 commercial variety nickel are 101954-35--1 101954-35- 1 101954-35--1 1 while ferrous iron and quantities. This 101954 _35_ commercig] variety of (1) January 4, 1935 2 January most January one of the cfooumrmoenncoluynte2 red encountered encountered is designated as chrysotile and asbestos most commonly commonly designated chrysotile chrysotile and it varieties one the four varieties varieties usually occurs of mineral mineral (and presumably asbes- seams mind that silicosis and and presumably presumably presumably asbes- asbes- 25 hazard there does does there appear to present clear true cut which unescapable unescapable communities with silicosis such hard rock mining mining may true silicosis some the the asbestos plants plants are communities communities may may typical effects a recent origin for would a not silicate dust dust to become become manifest apply the the manifest plants fabricating only industry dust on the are Data the fabricating plants are included in this study designated designated report as plants A B C D and E. the This is preliminary preliminary more extensive study of the asbestos report and industry a DUST STUDIES Apparatus Apparatus methods methods sampling Both the Apparatus precipitator precipitator were the impinger samples samples for the electric electric used for the collection of air for Both dusts breathing levels these levels and close proximity to the workmen forms apparatus apparatus adapted for this workmen taking taking the the solution some c some might present present The The j driven rotary pump and and t] means of resistance resitance type type of measuring measuring measuring pressure pressure . dust collected from volum volum volum electric precipitator precipitator is de: used for recovering recovering di electrifying depends on electrifying through through clectrostatic clectrostatic fic upon sheet sheet of celluloid operating draw of transformer transformer transformer alternating Air draw draw dray fan run by motor motor the the meter . Samples dust brushed chemical from | were secured hygiene chemical laborator ap accordi industrial industrial made a counts were Bureau Mines States Bureau Particles size 1 Service Particles counted in size i diameter analyses were Chemical accepted stand : according plant plant studied stand: the were counted counted has (A) silica particles particles exceeding mic mic be silica meter thousand thousand mic diameter diameter enter the lung tissu usually considered considered when when : appeared from from some p asbestos particles much larger larger in p decided count particles and in microns and under under foot : Total particles particles cubic in milligrams were obtained obtained ; dust counts and correspond correspond not included in the and Table Table shows by plants milli minimum minimum dust dust counts plant a Although counts plant plant a Samples microphotographcsollected both impinger impinger and a microphtographs slide projector enlarged enlarged particles particles measu th measurement ) was easy calculate logarithmic logarithmic probability paper logarithms of en! plotted ordinates against logarithms occi the probability probability occi th plotted Plotted Probability paper, the logarithms of as ordinates against the Probability of occ. 2 2 ules js designated as chrysotile and of the designated designated chrysotile chrysotile and of dust included included zht might the fourth variable variable variations susceptibility susceptibility ght the assumed that those in os ght rence asbestosis asbestosis North America communities with true 0communities communities communities It silicosis some of recent recent origin be some effects of for typical ne manifest but this apply apply to plants he fabricating fabricating wing service Metropolitan Insurance Metropolitan Metropolitan period period 1931, wing investigation during litions 1931 which included mines and mills Canada alonlgitions asbestos Seaboard Seaboard in United ons of of asbestos workers including including austaust systems designed eliminate asbestos $ g plants only are included included ort as plants plants plants A B D and this study oreort E. This This extensive study study the asbestos DUST DUST STUDIES * 3 of sampling Both 2) were were were used the impinger samples levels levels levels and the collection collection workmen Oparatus pparatus pparatcusloadaptsed aedapteprdoximity proximity work set up set and adjusted this taking taking level, adjusted efficient efficient . level ca ovn eredd extremely container the dust the then surface aspirating aliquid in container surface covered covered containing aliquid Ued lled water containing percent alcohol containing percent to pie ch cally driven a resistance resistance resistance of flow meter with an sample represents represents ter dust collected from sample air volume volume 100 cubic Cottrell Cottrell precipitator representg precipitator Samples of dust brushed analysis also were secured for analysis All samples were shipped shipped dtuhsetindustrial hygienelabaocrcatoorrdy it nghtoethe Metropolitan Metropolitan Co. thtehteo counts were Bureau methods Public Health the United States Particles in Mines the United States greatest Service were counted insisizzee up 360 microns in greatest ggrreateestattehste up to 360 and diameter Chemical analyses combined combined silica Chemical the accepted standard standard method of microns and under usually are considered considered when when determining published ii t t appeared appeared some the articles 4 English that published asbestos particles much larger larger found lung was was make decided count all particles and differential counts all those 10 microns microns under under make were differential in lung weight it 10 Total particles foot and corresponding the particles corresponding weight of the dust milligrams milligrams were corresponding corresponding weights found the weights weights Ain plotted ordinates against plotted easy to calculate the logarithms Probability Paper, the of original Particle size (5), By the the function to be use of Hazen s(6) measureg (in this case microns) are vanuary 4, 1938 4 all and in the other plants are 4 January as in no Particles, direct sample 4 were the comparison ig January and plants plants for all comparison comparison comparison 19 particles direct direct comparison no possible sample taken percent than than 94 percent peo rcent f whthoe wlheole Particles per cubie foot and minimum air Plant D Plant E Department E ee ber Million ber of Num- Milion Million ber of Million Milion sam- parti- | ples ples cles | per per cubic cubic Million parti- cles per cubic foot of air Preparation... foot Hegrene Ring tra aoe Preparation wong) spin ing frame Ring spinning Mule spinning Mule . Twisting band Weaving Weaving ; 162 -43 - oa e a8 ir 34-434 32-151 J -82 ~82 -76 515-10 512-10 7 367 106-1934 13-442 percent asbestos be higher principally In asbestos correct but other consisting of of mately the insulating material consisting consisting asbestos is but cotton lining In the total material udsepare tmentd s departments of molded percent percent and clutch division of plant comprises about 25 percent of material material material The actausabelstexoposurse expcoompsriuserse adsubsetstos dust therefore isthceontsoitda-l counts in table 1 CONDITIONS CONDITIONS THE PLANTS The processes in these mills in The plants were very similar processes to those preparation illustration of mills mills in general illustration process process the room plant plant For detailed length preparation room the here received in Asbestos Asbestos received shoveled These These emptied for about minutes minutes in the asbestos asbestos crush into pug mills and run about asbestos in order into and open the From there asbestos trucks wheeled wheeled either horizontal horizontal hoppers passing textile mills Pr e trucks which which which are into trucks these in sa in the fed discharged from from thesaol shaking shaking screen where where suction hood blown into a into a fibers fibers falling through the th, making making asbestos asbestos cement cotton received received cement bales in bale openers discharged discharged discharged vertical and horizontal opener j) opener cotton cotton the waste mate opene: As needed a mate these materials mixture proportion proportion proportion through through materials passed passed mixture discharged from picker tbhyrough a ; material then taken m it is Two the by a m the card card system conveyor while th of thy which conveys the device which the a th: room grades material two the two grades material the sa two Ss! with an spray 1 the equipped entrap small small asbesto g, cotton fiber throughout throughout theasbp esto J weaving cotton Incidentally Incidentally appa the p amount material is s this point but the appa diminished diminished to time is s. than percent percent percent time mineral mineral was used eficaious apparently not efficacious efficacious efficacious attemp in the du ustsed was there Carding machin as exhausting exhausting humidifying Carding there was ventilat ventilat humidifying plant depended depended natural hun equipped machines were equipped plant cardid n uhusn relative spinning percent percent One One plant C humidity department department and also the humidity humidity 76 percen C Weaving room of plant A, 4 re for all particles direct comparison is taken were the number of particles 10 an 94 percent of the whole num dust counts in million particles by plant and department per cubic foot Plant B Plant C Plant D Plant E J | Num- Million Ser of cles parti- sam- ples taken taken Num- Million ber of || sam- particles per ples taken cubic foot of air Num- | Num- ber of cles | sam- Million particles per ber of sam- ples | { ples cubic| cubic taken fo t | foot of air cubic foot of air Million parti- cles per cubic foot of air 13-1 weeeee Me 4 8 334-10 334 fT 3 6-7 10-1934 pepe 2 16-34 16-34 * Includes broad loom weaving preparation room is he case in the practically all due to other departments In the aving rooms asbestos ised comprises about 25 On special jobs the ut in general the figure percentage of material quoted is approxi- ents of consisting principally of cotton plant A asbestos is but 5 In the molded percent lining and clutch os comprises about 25 percent of the total osure d in to asbestos dust therefore is consid- the dust counts in table 1 TIONS IN THE PLANTS lants were very similar to those in ration the process in the cotton at length preparation room / ags These are emptied upon the floor to pug mills and run for and n the fibers about 5 minutes From there the wheeled to asbestos is hoppers with either horizontal to those used in textile mills After naterial is discharged into trucks passing first Waste run through a garnet machine and Ne 5 January 4 1935 dumped discharged into trucks which are wheeled to material is fed into these in the the openers and the After being discharged from same manner as is the the new material vibrating or shaking opener the material is put onto a a suction hood and screen where the long fibers are picked off by blown into a bin to be used The short fibers falling through the again in textiles used in making an asbestos cement screen are either sold as such or The cotton is received in vertical openers It is bales opened and also run through the vertical and horizodnitsaclharged into trucks The filled trucks from fiber the cotton or the openers containing either the asbestos bins waste material are taken to As needed these materials separate storage are weighed and onto the floor in proportion to the mixture desired and the materials are then passed through a mixing picker is discharged from the picker it is resulting mixed As this mixture The material is then taken by a mecshparnaiyceadl with a light mineral oil bin in the card room Two of these conveyor to the storage this conveyor mixing pickers discharge onto system while a third machine is suction device which equipped with a conveys the material to a card room The object of the two storage bin in the of two grades of material systems is to facilitate the handling not equipped with at the same time The third machine is an oil spray The object of the oil marily to entrap the small asbestos fibers spray is pri- in the cotton fiber and hold them enmeshed weaving throughout the processes of Incidentally it is carding spinning and amount of dust The apparent that it also diminishes the oil at this material is saturated with about 4 percent of point ; but by the time it reaches the diminished to less than 1 looms the oil had percent exhausting While mineral oil was used in the apparently was not preparation room of plant C it as efficacious as in plant B. In plant E oil not used nor was there was of dust any attempt at humidification or any system there was a Carding machines were fed by hand In plant A humidifying plant B depended ventilating and heating system while on natural humidity In plant E the machines were equipped with a exhaust carding efficiently used In plant C system but it was not which was equipped with carding was done in 2 buildings 1 of an buildings conditioning Two the machines had exhaust equipment system and in both plants B and C had artificial spinning rooms In the former the humidity installations in their humidity 78 percent One temperature was 76 F. relative the twisting department plant C had a humidification system in and also in the weaving department where the relative humidity was 76 percent with 69 F. as a bulb temperature of compared with a relative humidity of 44 percent in the weaving room of plant A. January 4, 1935 6 would 1935 from plant E, it 6 January except in the appear that the dust hazard was appear that dust not hazard hazard Aside from plant was not The excessive the preparation appear rooms plants and and The The the dust counts interesting interestpirnegparation considered considered light of the permissible permissible standard when established established by the standard Service granite namely about million United million particles States Public Health Service 10 microns foot However particles microns and per not justified justified available information suggests that asbes- assuming that because available clinically silicosis of the threshold threshold of - DUST CONTROL humidification exhausts Various measures, such DUST CONTROL Various Various measures such such local exhausts humidification Various Various reduce dust Nevertheless Nevertheles Nevertheles humidification and local they they tended only partly successful Nevertheless was evident dustiness in were final If it expected properly constructed reliance reliance must must upon exhaust properly these equipment equipment In equipment equipment equipment plant C one department experimental installa- department experimental experimental spite of equipment on tion basis comparative comparative some faults the dust 50 percent percent the and counts reduced the dust with further further alterations will percent effective this such probably satisfactory is neither neither practicable practicable practicable reduction nor seemed quite install such economically economically desirable desirable equipment as normal defensive mechanism application when body exposed exposed defense mechanism mechanism breaks The equipment to textile machinery involves is considerable considerable considerable considerable especially where the construction of the is such thatdifificsulty pdoisfsfiibclueltey xespheciallay aupsptly down suction to the loploamnst It desirable to install then apparatus in any plant on an ex- perimental perimental basis check its efficiency by dust first and saving saving needless counts expenditure of money PHYSICAL EXAMINATIONS X ray films were made of in ray films plants in persons United 108 men 18 women were in asbestos States All but five of these examination The cases less at given physical among those were selected more employ- employ- at at random having more than than years early industry of ment . It was obvious that the diagnosis asbestosis must rest to large extent pictures diagnosis extent clinical pictures symptoms of experienced experienced field . field. minor nature and was ge was ge films were read conservative conservative examination age of th of {] only when there no was no guided their their experience experience moconioses films classed as a: subdivided doubtful and anc the individuals classed a asbestosis Particular Particular at absence indications indications indications of tub: reviewers films films were felt in acc silicosis silicosis mind was felt possi felt : devoted ascertaining infection . possi disposes tuberculous tuberculous were cases of asbestosis first were , second stage definite lung lung st examination examination pneumo warrant diagnosis second stage lung stage symptoms second symp , pathology also individuals were these practicable practicable make symp an aci was not disability disability any in an. extensive pulmonary pulmonary involveme involveme in extensive they would total such cases found would } Of the total of X ray second degree asbestosis asbestosis 63 fir e: negative definite 63 ag fir There relation to the years expo in numbers make it impossible + impossible to d enters this increase increase to d enters into TABLE Classificati TABLE 2. Classificat;. Years of exposure active active about One asbestos worker (second this study, but is Still active aSbtoaugte)hirsetgiarreddeonf, his 6 the vould 6 that the dust hazard was not vould appear that dust hazard hazard was not , vould appear rooms plants B and The The eparation when considered the light 2 too dust established established by r granite granite United about 10 million million particles cubic However we not justified available information information suggests that asbes- clinically than higher higher Asbestosis silicosis threshold threshold threshold Asbestosis appears to be patho- icosis icosis and experience experience far does DUST CONTROL CONTROL 4s DUST and local exhausts be oiling l. t Nevertheles Nevertheles humidification humidification and exhausts they Nevertheless it was dustiness they usI tf it expected control 2 must upon properly constructed ienxsthaalulsat- olufstone department department experimental equipment equipment some obvious faults faults dust by percent ons lust counts reduced be percent effective ion ons probably satisfactory percent It neither uly seemed seemed quite satisfactory equipment equipment lust ally desirable desirable defensive mechanism v fair free amount atmospheric pollution ed to fair amount . excessive amount of dust that > ed ust down equipment to machinery involves ust equipment where construction construction of ile to Decially down the draft suction to the le exhaust apparatus 1 then exhaust check in any plant on an 0 efficiency efficiency by dust n saving saving expenditure expenditure money SICAL EXAMINATIONS f 126 126 persons 108 men women women of United States All but five of these nm. on The cases were selected of employ- lose hose having more than than years Was diagnosis was soon obvious that the pictures ) a o large extent on ray pictures symptoms tages tages tages silicosis the inconclusive symptoms usually indefinite inconclusive ms are ms based based one been readings reviewed by rat they they have been reviewed by if 4 Fi 3 r 7 1935 4, 1935 others experienced nature there was general minor nature were read conservativelyindividual physical examination examination and age of the general agreement interpretation interpretation individual into account were classed as examiners were examiners disagrement ag disability stage Particular were guided their their experience silicosis of pneu- silicosis other types further further moconioses The films classed subdivided into negative negative asbestosis asbestosis can further doubtful and tell whether the individuals classed negative progressing toward toward tell definite asbestosis doubtful doubtful focussed the presence a or absence of indications attention and this respect all the tuberculosis tuberculosis the unhappy unhappy reviewers of the films were accord of accord great deal experience experience the silicosis in mind it was felt that care should devoted to ascertaining possible whether whether not asbestosis asbestosis pre- bo disposes to tuberculous possible whether or not asbestosis The infection cases of asbestosis first embraces embraces pre- and second stage The first those who show by ray examination pathology pathology sufficient extent extent definite pneumoconiosis pneumoconiosis have no by warrant a diagnosis of definite to symptoms The stage exhibit more extensive extensive lung definite symptoms exhibit pathology and also definite actively more work and All these individuals 2 it was not practicable Had make distinction distinction the basis working exhibited any individuals individuals found found who exhibited ability or disability involvement extensive involvement and marked physical disability or total disability would been physical disability were found have classified third but Of the total 126 ray been were diagnosed diagnosed as second second degree asbestosis asbestosis negative 63 degree as doubtful and There asbestosis 63 as the percentage percentage diagnosed ag diagnosed positive positive positive There relation relation the years exposure exposure in numbers make make impossible impossible determine table factor age Small enters into this increase determine determine how far factor 9. enters into this to determine how far the factor of TABLE age TABLE 2. Classificatioonf cases by years of Number Years of exposure 10 5 years 5 to Under Under years {lo HO Total rte onder 9 Total irr Petal exomined. 0000 ee --- -- worker still active 7 to One this asbestos worker (second Stage) Study, but is still active about retired his of his garden. Own Percentage Doubtful : Positive 32322 Positive 11 32322 **** 33815 39 58 33815 20 50 30 39 2 43 continuous 25 3 10 12 not 67 10 previous 21 not continuous. accord, because of old age, 10 years previous January 4, 1935 8 Of 1935 64 Persons given 8 examination and given January positive physical physical examination diagnosed ag diagnosed Of the 64 persons persons given physical examination and diagnosed having positive asbestosis asbestosis examination entirely entirely free free from symptoms while doubtful entirely with diag- of doubtful symptoms and Dyspnoea Dyspnoea negative diag- the noses were free from symptoms symptoms none and cough were the symptoms symptoms most complained complained wind these these cases exhibited the urgent or evident type negative seen true silicosis silicosis Several of classed as stated that they short winded winded " negative and recorded subjective symptomsmuch should not placed placed the statements statements subjective symptoms During the progress study study physicians were practicing the communities communities the lived were where where not questioned asbestos workers lived of tuberculosis stated that did The find an unusual amount state tuberculosis among among these workers workers contrast between hazard affairs community noteworthy with The incidence incidence of tuberculosis noteworthy upon ray films given given in tuberculosis based upon X films the table The incidence years given employ- industry 3. nIeidence of tuberculosis Tuberculosis (healed) Tuberculosis (active) Tuberculosis Tuberculosis Positive Doubtful Negative 1 Total case was diagnosed ag Probably active on the X-ray findings This case diagnosed probably as to physical signs of chest trouble TABLE Chest findings NPhoyspihcyaslicsai]gns of chest trouble Not chest Physical physical signs Not Positive Doubtful Negative asbestosis ' At least 6 of these ? 2 of At least showed no 56 of At these these showed associated associated evidence associated with no evidence associated found with usual signs asbestosis asbestosis What significance significance any can can attached to the What significance " on hands hands workers presence 18 asbestos asbestos asbestos positives positives 12 out appears doubtful others others percent doubtful 7 out of of and and percent such corns corns doubtful negative negative 2 out of showed to roentgenologist roentgenologist reviewed reviewed called attention to Each fact that these X films unusual incidence enlargement enlargement of indicated indicated that unusual enlargement enlargement the heart It probable that upon this compensatory compensatory efforts due to additional additional the work upon upon heart heart efforts pump blood through the the fibro attention been paid paid paid 1 the heart attention workers had changed fro fro during one plant another another during industry Since only only th this survey survey the variou variou variou: way knowing knowing the average y ; by these people over y the x quently not possible possible corr to corr. amounts dust exposure exposure INSURAN: throw light on analysis relations of tuberculosis tuberculosis was mad of disability claims having availa mac insurance insurance having involved avail; were death claims are so clusions years death reached from a so the sickness sickness cla a epi number true claims for respiratory respiratory cla number claims for the others studied low 1927. However However du a experience 1929 there du part records 1929 one establishm establishm establishm epic claims and of 10 perman listed due pulmonary pulmonary pulmonary tuberc tuberc ordinate amount amount of tuberculosis f employees were Negroes Negroes f; ally this section of the end diagnosing diagnosing pneumoconiosis pneumoconiosis pneumoconiosis and sti tuberculosis claims sti treated and claims investigated the individuals includ sti sanatorium sanatorium records includ investigated following re with the exposed ri 1. typist intestinal Colored Colored age Colored 27 pulmonary months sanatorium sanatorium mont ! mann evidence evidence 3. Colored asbe ; male age w months Colored died pulmona pulmona hospital hospital Cavitation Cavitation both lu \ hospital died of pulmon: Ospital, Cavitation both lu 8 entirely only ned doubtful doubtful free from negative diag- and out of i ymptoms ymptoms with were the cough Dyspnoea Dyspnoea and ned of none exhibited at " short of these silicosis Several lve seen were short short stated emphasis should winded ut much emphasis emphasis not placed placed cre symptoms symptoms progress the of practicing During communities communities communities where teof questioned and stated they questioned and among these not these tuberculosis that workers ate affairs noteworthy noteworthy basneotdeworuthpy otnhaXt films) is given given ray films given > 3. Ineddencoef lubcreulosig of Positive Doubtful Negative - ms me3 9 mn 67 39 | lv active 20 on the X-ray findings, _ ion as ly physical physical signs signs chest ABLi E on Chest Positive Positive Doubtful wis, associated associated ice Associated with nfsound ace _ asbestosi SiN Of signs asbestosis asbestosis ly . ly any, can any hands of can attached attached doubtful doubtful hands appears 12 out of 12 out workers of the sative, 2 gative gative 64 and percent percent such ho 2 out showed ho reviewed reviewed the films 'ms Ims ray unusual indicated indicated very this It is It probable probable put compensatory Iditional Iditional heart Iditional work put upon the efforts 9 : knowing departments individual lungs to pump through through fibrosed Jenuary 4, Bscnt) pump through been paid It possible pneumoconioses pneumoconioses thas. sufficient attention attention the effects effects the pneumoconioses pneumoconioses no Mantyhe workers changed changed one another workers plant another another department employment employment the their years dust collected and asbestos asbestos industry only the amounts departments are collected in the time way knowing survey the various departments average average known there ay the the atmosp^rna atmosp^rna is their employment employment employment Once- quently is not not possible correlate Once- correlate cases with datwite, relationship between To throw light on analysis disability adreaeth 36 disability nary tuberculosis manent claims was made claims companies cauuying cauuying regard companies companies cauuying group insurance claims available available figures figures exposure cauuying and involved with total 7,009 - MRE There were death claims years The death reached small number number figures figures clusions from any subdivision subdivision The det. cannot be sickness claims health insurance The same number of claims for respiratory claims health two of plants number number low for diseases compared with studied experience of 1927. others compared latter part part Metoprol^>tium experience of 1929 However However during 1928 1928 and the influenza influenza the was first The records records one epidemic plant showed showed that death establishment establishment establishment total that 36 Bags claims and 8 listed as to pulmonary pulmonary permanent This This appeared ordinate ordinate ordinate pulmonary tuberculosis this plant be im- 33 amount tuberculosis However Negroes the employees were also tuberculosis many gemer- claims are diffinity in in the high this pneumoconiosis andcoutnthryecountry Realizing confuse with ef tendency confuse piouns tuberculosis treated individuals were who who and treated records records including interviewed available and sanatorium with following results investigated results with Death claims typist including dust exposed exposed Death, intestinal interviewed film were were film were and the fy portal pulmony pulmony and asbestos 1. intestinal Colored male months pulmonary died pulmonary tuberculosis tuberculosis following following 2. was sanatorium evidence of asbestosis in healing Wassur mann mann No was evidence asbestos planta planta acad In Colored worked acad mann, male pulmonary months Cavitation Cavitation tuberculosi tuberculosis tuberculosis after month of 3. hospital both asberika asberika months; Cavitation Cavitation died of Cavitation worked in asbestos Ospital, avitationpulmonary tuberculosis plant, 1 Aye after both lungs; no evidence 1 of asbesti, : A 10 4. Colored 6 months. male, age 34; worked in Plicated 10 tuberculosis. believes asbestog plant 2 this years Was not was 9 case of and in asbestos plant years years uncom. and plicated information tuberculosis tuberculosis Was obtained information information could obtained other other information permanent permanent obtained claims his two cases disability plant observation plant physician physician marked physician observation in asbestos years His physician estabof states case tuberculosis tuberculosis observation with old employ- cervica] lished started Also had tuberculosis the kidney tuberculosis glands started tuberculosis employed asbestos plant kidney cervical months physician physician physician bacilli old states finding of sputum sputum tuberculosis months tubercle in as- available No ray according physician in sputum sputum physicians physicians physician treated employment treated treated 1s not t predisposition predisposition tuberc to tuber: predisposition . this Asbestosis observed in observed in { disability case in any case, known known known how much how pneumonia acute nontub much nontub nontul: not practicable practicable practicable yet as yet t content air of the amount amount dust the : in substantialy reduced reduced, the , RECOM; recommendedseriously the industry plants industry seriously Seriously employees Of three their employment and time Of employment the asbestos was and Of were udnciomsplaicbatiedlity asbestosis uncomplicated who tuberculosis because because of uncomplicated diagnosis munity tuberculosis mistaken mistaken diagnosis diagnosis munity due com- were put on In this asbestosis know one uncomplicated an industry. employment employment the asbestosis asbestosis in an frequently 2. silicosis silicosis be Cases definite 2. associated fi Personal with Personal enlargement enlargement found to examination of the chest 2 s thi. industry industry sponsor sponsor as studies on effects sponsor as well as studies s ACKNOW ACKNOW of ast; tl making making study companies ployees the companies t] gave everay sfabcileitsy tPeonsnsyclomvpaanineis asecurin possi University University for L Pennsylvania and to L preciation Charleston Charleston Charleston C. in lis pathology pathology pathology the Dr. asbestosis * Dr. Joseph Fellows Fellows of Wyatt assisti for ir Dr. Paul York O. for Lancaster + Snoke of Lancaster Danville Quebec Quebec to Cummings Cummings Cummings Canada Saranac Lab pathological Saranac study pathological effects pathological Kenn to JourboMeddiAsseocs sputum and vol 1 * Aug. effects , sputum Asbestosis bodies in Jour. Am. Med. Assoc., Aug. and lung, By Kerr 30, 1930, vol. 95, no. 9, ; 10 ige 34; 10 in sician 10 asbestos plant 2 this years and s. Was not worked asbestos was 9 case of and Id age asbestos plant worked believes this was years ysician not case sanatorium 5 obtained obtained the ame isability claims claimosther two cases isability isability asbestos with His physician physician d plant years asbestos observation observation His estab- with asbestos employ- i in culosis tuberculosis tuberculosis had tuberculosis the months kidney cervical asbestos months physician physician ound fibroid fibroid plant months tubercle bacilli available but Sare ound sputum . apchycsiociradnsinphygsicianpshysician physician who treated employment treated > W are inclined inclined to z asbestosis of reexamined reexamined believe time investigation His investigation reexamined His fine of nourished looking diminished color fingers expansion incessant disseminated diseminated through second Years of tuberculosis tuberculosis Probably ' Case. years asbestos Is now sanato- id years plant Is now he has with pulmonary physician pulmonary states that in ong with tuberculosis tubercle tuberculosis asbestos factory long and This patient locate factory factory - had locate manner three cases of total diagnosed pulmonary locate diagnosed disability asbestosis uncomplicated nN Cases, the asbestos dIn asbestuosnis complicated nosisof asbestosis were were athdue gnosis tuberculosis tuberculosis this same the s ath uncoemploymment pelmploiymenct ated uncomplicated asbestosis asbestosis CONCLUSIONS ' asbestos asbestos asbestos dust heosis and demonstrable licosis pulmonary demonstrable demonstrable milder iac iac enlargement were frequently to disability standards asbestos predisposition predisposition predisposition study indicated this observed Asbestosis observed this series cases cases marked disability disability any case . cases had not resulted in 5. known known much asbestosis asbestosis pneumonia acute nontuberculous pulmonary infections infections . pneumonia pneumonia pneumonia practicable nontuberculous asbestos 6. practicable yet to establish establish content air . standards for the dust The can be amount dust in the air in the asbestos substantially reduced asbestos plants Studied can It is recommended- 1. That the RECOMMENDATIONS industry asbestos plants seriously the the physically including 2. That including ray in new employees and examination of the rejected employment pneumoconiosis pneumoconiosis rejected for they X-ray tuberculosis or 3. examined preferably every year show That employees years but but least this examination examination the chest chest this include known every , the industry industry cases asbestosis asbestosis 4. That studies studies effects asbestosis 48 as well studies asbestosis on heart asbestosis, on effects ACKNOWLEDGMENTS ACKNOWLEDGMENTS cases of ACKNOWLEDGMENTS the heart and Sitntearptreteinsg filCoomperastive PicherUnited expressed who followed express their sincere aided making making this aided ployees the asbestos study possible cooperated cooperated the fullest and gave gave facilitycompanies securing also Dr. extent the and Pennsylvania his Pancoast advice in University University Pennsylvania Pennsylvania interest valuable valuable advice interpreting and F. Meriwether Meriwether Meriwether United Bureau BureauPublic Health Cooperative SCoeoprervatiiveceClsiunrgiecon Clcinichianrge charge United inteStrate-s Stiatnes Mines pretation pretation of listed in this report is whose whose Ap- Smith preciation preciation preciation also Charleston C. Dr. Atmar Kenneth advice particularly Lynch Lynch Charleston information information information and advice particularly as to pathology asbestosis asbestosis 4 Dr. Charleston Charleston pathology 48 to S. Joseph H. Wyatt W. and and H. Newark S. Fellows New as isting interpreting interpreting York films Cs Fellows Paul Snoke Snoke assisting assisting interpreting interpreting R. Stevenson Stevenson Dr. Danville Danville Quebec CanadLaana casn ter dLancaster DDr. r. Gardner Gardner and Mr. Donald Donald Laboratory Cummings Cummings of undertaken undertaken dust the Saranac study Cummings pathological pathological Laboratory asbestos Asbestosis bodies in sputum effects effects of the inhalation W. Atmar dust Study Jour Am Kenneth Assoc Smith Lynch D. undertaken Asbestosis bodies 1930 no pp 659-661 of the Jour. Ain. in sputum and Mea, Assoc., lung. By Kenneth asbestos dust Aug. 30, 1930, vol, 9, M. Lynch, M, D,, end w, no. 9 pp. 659-697. Atmar Smith, M. p. ONALYY By 2935 12 12 through animal 1935 Life Insurance 12 with the aid of 4 grant from the with Metropolitan Metropolitan Insurance and Paratus as REFERENCES REFERENCES The used by the REFERENCES REFERENCES Publie impinger Health dust sampling ap- Rep., vol. 47, no. and Bloomfield 1 Greenburg Leonard Bloomfield J. impinger sampling ap- Health Leonard Bloomfield States Public impinger dust p Reap ratus 1932. Service Reprint no 1528 Pub suspensoids by suspensoids suspensoids suspensoids by June 2 Drinker and Thomson alternating current precipitators precipitators Jour Ind Hyg vol rocks. carbonate (4) 1925 W. W. precipitators carbonate Bull, 422, analysis 3 Hillebrand Hillebrand W. silicate and carbonate rocks Dee, 38, 1927, Geological United United States Pulmonary Pulmonary Washington Washington Jour 1927 of Cooke W. ( Green paint paint rubber asbestosis Med determination determination particle particle pp. size size pigments Jour Franklin and ( Whipple 637 G. Vital statistics Sons, New 1925 1925, Whipple . workers statistics John Wiley and and Bloomfield Russel in H. Thompson Thompson and .: The The Britten Britten Thompson Thompson II Bloomfield Bloomfield J granite Exposure No. ENDEMIC TYPHUS IN By J.N. Baker, ENDEMIC ENDEMIC ENDEMIC TYPHUS ALABAMA D.P.H., M. JAMES TYPHUS ALABAMA D. and G. GILL MCALPINE MCALPINE Ph M. D. D., Montgomery Ala State INTRODUCTION ference ference State Provincial Provincial epidemiological ference ington the authors authors aspects of ington typhus it occurs discussed epidemiological epidemiological southern southern southern increase in endemic In that report was was this disease typhus that there had been a rapid increase in certain Southern Southern States is shown incidence That other countries have experienced experienced experienced incidence evidenced by the figures in table table between of this The distinction between epidemic typhus and the endemic in of this country recognized recognized 1898 by Brill He found & was first type fever typhoid gave resembling which itsthe United States type further demonstrated demonstrated character negative negative Widal typhus showed studies studies ( milder showed that was milder a Also and household less contagious contagious that Also Also he reported was prevalent during Anderson and Goldberger winter spring spring In Goldberger Goldberger Anderson identical (4) instead of that Brill's disease immunologically immunologically ( proved typhus Naturally it was Mexican louse before 1 Read before the 5 ept. 3, 1934, tabardillo laboratory section section the . American Naturally Public belief this led to belief Association, Pasadena, that that Calit., 1 Typhus incidence incidence incidence i; a Gerda nnn = nn Georgia____--_-. 4 / 222 TITDT : Alabama. 277 a exes ------ aan. i only July 1 to July 1, Incidence typh of typh Country South Africa exico . Epidemiological the Epidemiological Epidemiological . months months months . months. Report, Health Section Nevertheless endemic endemic (1926) noncontagious Brill's disease character its noncontagious louse its vector the appeared appeared and its among persons persons Sinc cases believe rats mice migh ha disease was carried man by fleas emphasized the migl; strata fact Brill's Brill's di fleas, society and bears no qi was taken when Dyer Rumre Rumre mn to recover the virus found found Brill's Brill's Rumreich Rumretiychp( hus19fo3ci3hpaoisnted pointed pointed Maxcy's Maxcy's fundamental fundamental athnedprobable probable vector suspect ted y arachnids tropical rat mite t vectors were head louse by