Document 8a1Brw7B97epK7G50JZ3zavd

FILE NAME: Philip Carey (PC) DATE: 1957 DOC#: PC027 DOCUMENT DESCRIPTION: Article from Home Office Underwriters Assoc with Cover Letter from 1963 Apr 6 4r, H J f.rUV H/ Zrb ' Z . i c o n<w ? M etropolitan it. Insurance 0.1?C -0(V f /I J R.IVnCh Sv*CvI3*. J M MCCHAN 5wMv,Oi 6*Ow* CMViSiOt* > C 7 S' April 6, 1963 Company '\` '*& 'V* lo ts C a a (W T o WC Cincinnati g OmiO TckCVMQttCi 721*0260 Mr. K arl X rieg , Employee R e la tio n s Manager The P h ilip C are/ M anufacturing Conpany 320 South Wayne Avenue C in c in n a ti 15, Ohio Dear Mr. K rieg A p p aren tly , th e jo b you asked the- Home O ffic e to do h as tu rn ed o u t to be nore d i f f i c u l t than a t f i r s t determ ined and th e b e s t t h e / are going to be able to g e t on s t a t i s t i c a l d ata vd.ll p e rta in to death claim s in the p ast fiv e /e a rs d irec tly attrib u tab le to re sp ira to r/ diseases. I t i s n o t considered v ery lik e ly _ th s t th e d iag n o sis o f acb esto o is would be shown on any p ro o f o f d e a th f o r t s t h a t wore su b m itted to u s and u sin g th e " r e s p ir a to r y " approach, th e y f e e l t h a t th e f i e l d can be narrow ed down and th e re s e a r c h e r v'ould be a b le to d eterm in e wc.at r e la tio n s h ip th e d e a th m ight have had, i f any, to a s b e s tc s is . The r e s u l t s o f t h i s review should be re a d y i n a v/eek o r so . I n th e 'meantime, th e Hone O ffic e has fu rn is h e d me w ith some r e f e r r a l s to j re f e r e n c e work on th e d is e a s e , along w ith a copy o f a p aper p re p a re d by \ Dr. Smith and Hugh Ja ck so n o f th e Jo h n s-M an v iile C o rp o ra tio n , end p e rh a p s t h i s in fo rm a tio n may be o f some i n t e r e s t . Ve: AV Group S u p e rv iso r JRL/ds Enclosures cc: Mr.' E. J . F aso ld , S e c re ta ry / f u r ... m:\LTii txri;iui:.NCL# amoko ahikotob wonKcna 167 ' T he Asdestos I ndustuy-- C eutaix U e a l iii E xrE nm xcE S Amo.no Asdestos W ojikeiuj n v KENNETH W. SMITH, M.D., AND HUGH JACK60N * In \uh presentation I shall try to outline certain health wpcr.vntcs which we have seen in asbestos workers, not only in my own company but in many other associated companies. While asbestOMs is a well recognized occupational disease, there arc relatively few people in the working populations of the United States and Canada who arc exposed to asbestos dust, and, actually, very few ever develop the disease. It will he shown that tho lives of the asbestos workers aro not shortened by their occupation, and also that work in these trades docs not predispose the individual to other pulmonary diseases nonoeoupational nature. Th <%ord " a>bcstv\>Mis generally used to describe several .'.brows magnesium uHcalcs which arc entirely different in ihcir chemical composition and in their physical properties. There itre several types of these fibers. The most important arc the chrysotilc, amositc, and crocidolitc. Deposits of these various types of fibers arc found throughout the world. Tho largest deposits ire in eastern Canada and Africa. The-e asbestos fibers arc highly resistant to heat and somo ;.ic resistant to acids. They have great tensile strength and large surface areas. Because of these properties, as well astheir filamcnted'structure, the industrial use of these fibers throughout the world is increasing. The textile industry has used these fibers for generations to produce blankets, clothing, threads, ropes, tapes, braided tubing, and filters. In recent years, however, there has been an increasing uso of asbestos in the insulation, building, and friction material trades. In addition, the fiber can be found, in wnllboard, s h in g le s, pipe covering, floor tiles, brake linings and brako blocks, cements, putties, and extensively in plastics. Historically the material has been used for many years. Those who are biblical sludcTUs will recall that in the third vmiplvr of Daniel the three men, Shadrnch, Mcshach and Abednego were thrown into the fiery furnace by Ncbuchndncz* Proceedings - Hone Office Life Underwriters Association 1957 1SS iIomk u n i c e l u x u.Nucm vniTi:nn ao.iociation zur. .h. k.ng of Babylon. They emerged from the fire com pletely unharmed, and archeologists today lead us to believe that they were protected from the flame by a blanket of woven asbestos fiber. Tints we can sec th at tho mineral lias been U sed for many centuries, but it was not until 1927--thirty years ago--that a definite occupational pulmonary diseaso was associated with (lie inhalation of this fiber. As previously indicated, the industry is finding many new uses for the fiber when mixed with other materials. It is an established fact that when asbestos fiber is mixed with silica or diatomaccous earth or other potentially toxic dusts, tho pulmonary changes resulting from tho inhalation of theso mixtures arc not typical of asbestosis. Tho X-ray pattern is - difu-r-. :>i.; the clinical course of the patient is changed, or the M-.sccp.ihility to intercurrcnt infection Is increased or de creased. "r-.i, in making a diagnosis of occupational pulmonary discaM*, it is highly important to obtain a detailed occupa tional history; not only tho job title, but also a complete list of raw materials used in the particular job, so that asbestosis, silicosis, or the mixed pncumonoconioscs can be differentiated. Wo believe that there arc fewer than 15,000 people in the United States and Canada who arc employed today in mines and mills where their potential exposure is only to asbestos fiber. In this industry the various mining, milling, and manu facturing operations create some dusts which are capable of being inhaled. If asbestos fibers from ten to fifty microns in length arc inhaled continuously and in sufficient quantities over a period of many years, a typical pulmonary fibrosis will develop. It has been demonstrated that this fibrosis is not due to the chemical, but rather to tho mechanical action of the fibers. The fibers arc deposited in the terminal bronchioles of the lungs. Then tho tissue reacts, coating tho fiber and forming what is known as tho asbestos body. This appears to be a defense mechanism of tho lung. Many individuals who have these asbestos bodies in their sputum have had only interm ittent exposures to the dust and have absolutely no evidence of tho disease. So it seems more appropriate to use the term "asbestos bodies" rather ) 7 I-** A.T* 3 <v*n 6 U i cr.itTAiN health KxrcniEKCEa amoko abdebtos wonKEna 1 8 9 than " asbestosis bodies,," signifying an exposuro to the fiber but not necessarily indicating disease. | If increasing quantities of the fiber nrc continually inhaled, the tissue reaction progresses and a generalized, diffuse fibrosis or scarring appears throughout the lower lobes of tho lungs. With additional exposure this fibfosis may spread to the other lobes of the lungs, resulting in respiratory embarrassment, and eventually cardiac failure. Vw<, v ,.'. v The pulmonary fibrosis resulting from prolonged inhalation of the fiber will produce a very typical X-ray pattern which docs not resemble th a t produced by any of the other known toxic dusts. ( The X -ray picturo should never be used to estimate the presence or extent of an impaired pulmonary function or disability. Many eases with X-ray evidence of advanced asbestosis have been known to carry on their work and live very comfortable lives for several years.^ There's no typical clinical picture of asbestosis. The discaso is very slow and insidious in its onset, and very slowly pro gressive with continued inhalation of the filler. The textbook signs of cyanosis and clubbing of the fingers nrc virtually non ex iste n t in the cases of asbestosis we see today. An X-ray survey was made of 708 employees working in an asbestos mill where the ore was (hied, crushed, separated and graded, packed and then shipped. Operations in this plant required the employees to rotate through various jobs, so th at it was impossible to relate any X-ray changes to a particular job or to a specified dust concentration. A t the same time, it could be assumed th a t all members of the group had been exposed to varying concentrations of the dust. The X-rays of these employees were divided into three groups: essentially normal; those with exaggerated markings, but not typical of any disease; and those with definite asbesto sis. Of the 708 employees studied, 619 or 91 per cent had normal X-rays. This is of interest, because-204 of the em ployees, or 29 per cent of the total, had moro than ten years of service. Two men actually worked over forty years in varying dust concentrations with absolutely no evidence of any inrrca^erl markings in their X-rays. Fifty-two of the 70S employees showed somo increase of nil peribronchial markings although none had any cvidcnco 100 IIOMB ovticn L i r a UNULnW IUTERB ASSOCIATION of asbestosis. Sixty-nine per cent of this group hnd moro than ten years of scrvico. Of tho original group of 703, only 7 had developed X-ray * evidence which could bo diagnosed positively as asbestosis. * These men exhibited various stages of pulmonary involve- * meat. All were working steadily a t their jobs with no signs of disability. It is of interest to note hero that none of the 0 men developed X-ray evidence of asbestosis with under twenty * years of exposure. `1 n Medical literature has given considerable attention to occupational pulmonary disease, bu t very little has been reported on the occurrence of nonoccupational respiratory disease among employees in the dusty trades. In order to determine the incidence of nonoccupational disease in a group of 1,561 men and women working in the asbestos industry, it was decided to study the claims submitted f^r sickness and accident insurance* All employees in tho survey group participated in the plan operated by an inde pendent insurance company. Indemnification was made only after the nature of the illness had been certified by the treat ing physician. The study included claims submitted over a five-year period for such illnesses as the common cold, sinusitis, pharyngitis, grippe, bronchitis, pneumonia, asthma, and pleurisy. Occu pational pulmonary diseases 6uch as asbestosis were excluded from the report. Of the 1,561 employees in the survey group, there were Approximately equal numbers in the dusty and nondusty occupations. .Of all claims filed for respiratory diseases, only 45 per cent were for employees who had a dust exposure. Not only did this survey show that the incidence of disease over the five-year period was approximately the same in each group; but it also established that there was no appreciable difference in the duration of illness in either group Also . clinical observations for many years had given the impression that a dusty occupation in itself would not predispose a person to more nonoccupational respiratory disease than, would a dust-free job, Animal experiments and clinical observations have shown that asbestosis docs not predispose a person to the develop- ccrxAiN HCALiii rx rtn iE K cn s amono agdeotos woiikkiiq 191 mcnt of pulmonary tuberculosis, nor does it aggravate an apparently healed tuberculous lesion. In two isolated oneindustry towns in the Province of Quebec whero asbestos was mined and processed, the incidence of tuberculosis over a * period of many years was no greater than that of other isolated ^ towns with comparable population, but without a dusty trade `-'In addition, the incidence of tuberculosis among asbestos workers ^ras lower than that in the general population in these mining towns. Conflicting opinions and different reports make it extremely difficult to confirm or deny conclusively the causal relationship of asbestosis and carcinoma of the lungs. Too often a common conclusion is drawn from observations and experiences with different racial groups living in different parts of the world, under variable socio-economic conditions and working in divoioe occupational exposures. To these variables I'd like to add the fact that there arc the various types of asbestos fibers, which may have different actions on the lungs. The Canadian experience with asbestosis has been limited to the chrysotilc fiber. The majority of industrial processes in the United States use this fiber, but recently.there has been iuinc increase in the use of amositc and crocidolitc. On the oilier hand, the British and other European industries use greater quantities of the harsher fibers, amositc and crocidolitc. Therefore, in trying to clarify tlio causal relationship of asbestobis in cancer, many variable facts should bo clearly identified, especially tho type of fiber used and whether or .'jvyA" '* J not other dusts, such as silica or diatomitc, were present in / the industrial or environmental atmosphere. To amplify this point I'd like to take a few moments to describe the three types of asbestos fibers most commonly used today. An electron micrograph of the South African blue or ' crocidolitc fiber would show that it is composed of many short, sharp spicules which arc rather brittle. Amositc fiber is brownish yellow in appearance and found in Africa and Australia. Seen under the electron microscope at the same magnification as above, tho fibers would appear longer, less sharp, and they actually aro less brittle than tho crocidolile* 102 home office l if e UKucnwimxixa association Crude chrysolite fiber found chiefly in Canada is greenish white in appearance. Electron micrographs show th at this i fiber is long, soft and silky. I I think th at it is reasonable to assume th at the short, sharp and brittle fibers such as crocidolitc and amositc could cause much more extensive damage to the lung than could the long, soft, silky chrysotile fiber. Therefore, I think it is unfair to compare the experience of some of the European operations with our North American operations, using different types of fibers with different actions. To amplify my statem ent th at there arc different occupa tional diseases having different X-ray pictures and different clinical patterns, I would like to describe tho X-ray appear ances of some of these diseases. The X-ray in asbestosis shows a fine, diffuse, infiltration, bilateral in both lower lung fields. The heart outline is shaggy or completely obliterated. The nodular or conglomerate patterns of other pncumonoconioscs arc not seen in asbestosis. In silicosis the X-ray reveals a nodular Infiltration which is bilateral and appears in all lung fields from apex to base. Conglomerate shadows can appear in any of the various lung fields. The homogeneous or ground glass appearance of asbestosis is not seen here. The X-ray of diatomite pncumonoconiosis can show an exaggeration of all linear markings, a very fine nodular or granular pattern, and frequent large coalcscent shadows usual ly in the apices. The X-ray pictures resulting from the inhalation of a mix ture of dusts never follow the same pattern and certainly are not typical of either of the inhaled dusts. In present-day working environments a man might be exposed to mixtures of silica and coal, asbestos and silica, or diatomite and silica. Thus you could have many bizarre X-ray shadows changing from fine granular infiltrations to homogeneous and later to coalcscent shadows in the samo individual. Several years ago, anyone who installed insulation materials was called an asbestos worker, because asbestos was practically tho only material used for this purpose. Today, however, there aro mineral fibers, synthetic fibers, clays, cement, mag nesia, and a host of other substances used in tho insulating CXIITAKf HEALTH KXrCniENCES AUO.NO AbtlESTOS WOIIKEM 103 ( L. trades. The majority of these materials aro relatively non toxic, and i t is obviously incorrect to label tho insulation installer today as an asbestos worker. There arc numerous articles in the medical literature today reporting the incidence of asbes'tosis or nsbestosis and lung . ' cancer among asbestos workers. The conclusions of the ' authors should not be accepted implicitly unless the report } clearly indicates th at the so-called asbestos worker was exposed^ only to asbestos fibers and not to a mixture of dusts. -- . *3 |ji-* m One company in the group I am reporting has a retirem ent plan which has been in effect for sixteen years. They havo a total enrollment of slightly over 21,000 people; but, of course, this figure has varied slightly through the years. Since they * started 'o use asbestos fibers ju st about 100 years ago, tho following review of the pension plan will include employees .. who have had an exposure to the fiber over a long period ' - of time. In the past sixteen years there were 1,185 employees who retired under the provisions of the pension plan. The averago length of employment for this group was 24 years. Although we arc.unable to determine specifically how many of these had extensive exposures to asbestos fiber, it is reasonable to assumo th a t the majority had, since asbestos is used in nearly all of the product lines. Of the 1,185 there were 180 who retired for - disability before reaching the age of 65. O nly/6\)f these had asbextosis. "s>---- * '"T his low incidence based on long employment with potential .. exposure would seem to indicate th a t the asbestos trade is ' not as hazardous as may have been indicated in the past. Conclusiona 1. Asbestosis is a recognized occupational pulmonary disease, . :< . * 6lo\v and insidious in its onset. I t takes many years of i . exposure to develop, it docs not progress after exposure t \ ce r* and there is very little disability until it is far advanced. : 2. There arc relatively few workers exposed only to this dust in industry today. 101 home o r n e e u r c uNoetiwiurciio association 3* Conflicting medical opinions exist concerning asbestosis. Frequently adequate occupational histories aro not ob tained so that other pncumonoconioecs aro incorrectly called asbestosis/ 4. Exposure to asbestos fibers docs not shorten tho life of the , worker, 5, Inhalation of asbestos docs not predispose tho worker to other pulmonary diseases which will shorten his life, C. The asbestos industry has controlled the exposuro so. that the incidence of asbestosis is very low. Ciiaiuman Lawson: Thank you very much, Dr. Smith, for being with us. It was a very interesting paper. Do any of you gentlemen have any questions that you . would like to ask of Dr. Smith while you have him available? If not, we will proceed to close. Dave Cartwright, I think, gave us a splendid report on taconitc this morning. The printed paper, of which you presumably have a copy, covers it in much more detail and has an excellent bibliography if you care to investigate further. We greatly appreciate what Dave has done for us. Morris Filler--thanks ever so much for moderating tho panel. And thanks to you, Chet Barney, Leon Hovey, Paul Shea, and Jack Wilson. If there is nothing further to come before the meeting, wo stand adjourned until 195S. I have been asked by tho secre tary if you will please--plcascl--leave your badges on tho table as you go out. Thank you all very muchl [The meeting adjourned a t 12:10 o'clock.] ti i iI. t * ' *