Document BRz64XOjMGr9BaLj7BpwbQoEj

(c:?y) December 21, 1934 Dr A. J*. Lanra, Metropolitan Life Insurance Co., 1 Madison Avenue, '!er York CIt7. Dear Dr. Lama: I an handing you herev/ith the gallez proof of your preliminary stud/ entitled "Effects of Inhalation of Asbestos Dust upon the -^ungs of Asbestos VTorkers". I an also enclosing copy of hr. Hobart's letter to ne of Deceaber 15th vhich. contains his conne.nts as to certain aspects of the study that he considers undesirable fron the industry vieTrpoint- I trust that 70U rill give his conrents and suggestions, as veil as those nenticned in ny letter of Decenber 10th, your most serious consideration. I an sure that you understand fully that no one in our organisation is suggesting for a nonent that 70U alter by one Jot or tittle any scientific facts or inevitable conclusions revealed or Justi fied by your preliminary survey. All ore ask is that all of the favorable aspects of the survey be included and that none of th unfavorable be unintentionally pictured in darker' tones than th circunstances Justify. I feel confident re can depend upon you and Dr. McConnell to gi7e us this "break" and nine and Mr. Hobart's suggestions are presented in this spirit. Sincerely yours. (0 n> sure Vandiver Brovrn Attorney 04037048 52 I \ <r?. , l V. -f-U. __4 . 't < I I EFF2CTS OF TEE IliHAIATIOE 07 ASBESTOS BEST EPOn THE IEHGS OF ASBESTOS WORKERS ( t Induotrial Health Service Policyholders Service Bureau Metropolitan Life Insurance Company Hew York J DEFENDANT'S EXHIBIT ZA 017 S 0 FOREWORD The authors wish to express their sincere thanks to all those who aided, in making this study possible, especially the officials and employees of the asbestos companies who cooperated to the fullest extent and gave every faoility for securing data. Also to Dr. Fanooast of the University of Pennsyl vania for his interest and valuable advice in interpreting X-ray films and to Dr.**>pOT. llerlwether, United States Public Seolth Servioe, Surgeon in Charge of the United States Bureau of .Bines Cooperative Clinic in Picher, Oklahoma, whose interpretation of all the X-ray films listed in this report is followed. Also to Dr. T. Atmar Smith, and Dr. Kenneth Lynch of Charleston, S.C. for in formation and advioe, particularly as to the pathology of asbestoBis;* to Dr. T. W. Wild of Charleston, B.C.; to Dr. Joseph S. Wyatt of Bewark, H.J., and Dr. B. . Fellows of Sew York, for assisting in interpreting X-ray films; to Dr Paul 0. Bnoke of Lanoaster, Pa.; to Dr. R. S. Stevenson of Danville, Quebec, Canada; to Dr. L. U. Gardner and Ur. Donald S. Cummings of Saranac Laboratory, who have undertaken the study of the pathologioal effects of the Inhalation of asbestos dust through animal experimentation, with the aid of a grant from the Uetropolltan Life Znsuranoe Company. * `Aebestosis Bodies in Sputum and Lung, Kenneth U. Lynch, B.D. and W. Atmar Smith, U.D., Charleston, S.C., Journal of American Uedioal Association, August 30, 1930, Vol. 95, Bo. 9, pp. 659-661. DEFENDANTS EXHIBIT UL 0 I3 i lETF.rrUCTIOH In 1929 the Metropolitan Life Insurance Company was approached by firms representing the ashestoo industry in tho United States with the request that a hygienic study he aado of that industry. The officials representing these firms vere desirous of ascertaining if asbestos dust was an occupational hazard in their establishments and., if so, what was the nature of this hazard and what should be done to prevent or oontrol it. About this time several artiolee had appoared in Xnglish medical Journals describing a pneumoconiosis due to asbestos dust. Vhile in one or two isolated instances tho oeourrence of this type of pneumoooniocis had been described in American Journals, the Industry itself appeared to be quite un informed of tho existence of any such occupational disease. The hazard of silica dust with special referenoe to the lungs has long been appreciated and a great deal of study and researoh has been applied to the silioa dust problem, primarily in the metal mining industry, in Great Britian, the United States, the British Dominions, as well as in other countries. Tho nature of the effoots of silioa dust expressed in the term "silicosis", with the resultant extraordinary predisposition to pulmonary tuberculosis, is well known. Theso effects have been associated with the inhalation of dust contain ing froe silica in varying amounts. The effects upon the pulmonary tissue of dusts containing combined silica - silicates - are still a fertile field for investigation, but ovidcnce is Accumulating that certain of these duote produoe pathological results quite distinct from truo silicosis. * nEtcuntuwt 3 The none osbestoeis has been applied to the pneusoooniosis caused by asbeetoe dust and It will bo so used in tills report. Chemically, the asbestos of commerce is a hydrated magnesium silicate consisting primarily of ' Silica 44.1< Uagnesia 43. Water 12.v while ferrous iron and nickel are present In small quantities. This commercial variety of asbestos most commonly encountered Is designated as chrysotlle and is one of the four varieties of the mineral serpentine, in which it usually occurs In seams. / It should be borne in mind that silicosis (and presumably asbestosis) / develops very slowly, taking from five to fifteen and even twenty or twenty- ^ five years to beoome established. This rate of progress is influenced mainly & by the dosage of silica which the lungs receive and this dosage, in turn, de pends upon three veiriables: the amount of silica in the dust, the quantity of dust in the air, and the extent of exposure. Individual idiosyncrasy might be included os a fourth variable; however, little is known of the varia tions in susceptibility in those exposed to dust. There does not appear to be present, in plaoes where asbestos is mined or fabricated in Horth America, the clear-cut clinical picture which is so unescapable in communities with a true silicosis hazard, such as hard rock mining communities. It might be thought that some of the asbestos plants are of too recent origin for the typical effects of a silicate dust to become manifest, but this theory would not apply to the older mines or to all of the tabricatinp plants. The Industrial Health Service of the Metropolitan life Insurance 2 'DEFENDANT'S [exhibit: Company undertook tho following investigation during the period from October, 1929 to January, 1931. This investigation included: A. A study of dust conditions in asbestos sines, mills, and fabricating plants. B. Physical examinations of asbestos workers, including X-ray films. C. A study of dust exhaust systems designed to eliminate asbestos dust. Asbestos fabricating plants looated along the Atlantic Seaboard were included in this study and are designated in the report as plants A, B, C, D, and S. Asbestos mines and mills in the Provlnoe of Quebeo are designated as P, 0, B, and I. The Canadian portion of the investigation was conducted jointly with the Industrial Hygiene Division of the Department of Publio Health of the Hedioal School of McGill University. The results will be summarized in a report which will follow the present one dealing with the investigation in the United States. DUST STUDIES Apparatus and Methods of Sampling: Both the impinger (1) end the eleetrlc precipitator (2} were used for the collection of air samples, for dusts, at the Breathing levels and in close proximity to the workmen. Both of these fores of apparatus are adapted for this work, as they are transportable, easily set up and adjusted for the taking of the air samples at the proper level, and are extremely efficient. The iapinger collects the dust by aspirating the air and then im pinging it onto a flat surface covered by a liquid in a container. The liquid used was distilled water, containing 50 percent alcohol to prevent the solution of some of tho dusts, particularly any silica which might be present. The iapinger was actuated by an electrically driven rotary pump and the rate of air sampled was oeasurod by means of a resistance typo of flow motor 'with an inclined manometer for measuring the pressure difference. Bach sample repre sents the dust collected from a volume of 100 cubic feet of air. The electric precipitator is designed upon the Cottrell precipitator principle used for recovering dusts and fumes commercially. This principle depends on electrifying the dust particles by making them pass through an electrostatic field and thus e&using them to settle out upon a sheet of oellu- loid. The electrostatic field is set up by means of a transformer operating from the lighting lines on 120 volts, alternating current. Air is drawn through the apparatus by moans of a small rotary fan, run by a motor, the quantity being (1)'Comparative Tests of Instruments for Determining Atmospheric Dusts*, Public Health Bulletin No. 144, Treasury Department, Washington, D.C. (2)"Determination of Suspcnsoids by Alternating-Current Precipitators*, Philip Drinker and Robert LI. Thomson, Journal of Industrial Hygiene, Vol. VII, No. 6, -unv, I'.'CJ. 2 DEPENDANT'S EXHIBIT o i: 2 r; -6- moasurcd by means of a floe motor. Samples of dust brushed from beams aud plpolinea near the celling also were secured for chealcal analysis. All soaplos were shipped to the Industrial Hygiene Laboratory of the Metropolitan and the dust counts made according to the (1) methods accepted by the U.S. Bureau of Mines and the U.S. Public Health Service. Particles In size up to 360 microns In the greatest diameter were counted. Chemical analyses vers made for total (free and combined) silica accord ing to the aooepted standard method of Elllebrand.(3) Percentage Prequency of Particle Size: In the first plant studied (A) only particles 10 microns and under in size were counted. It has been demonstrated repeatedly that no silica particles exceeding 10 microns - a micron equals one-millionth part of a meter or one- thousandth part of a millimeter - in greatest diameter, enter the lung tissue, and for this reason the larger particles usually are not considered when deter mining dust oounts. Later, as it appeared, from some of tho published articles(4) (English) that asbestos particles much larger in size were found in lung tissue, it was decided to count all particles and mahe differential counts of all those 10 microns and under. Both samples collected by the implnger and the electric precipitator were counted. Ulerophotographs of these dust particles were further enlarged by being projected upon a screen by means of a lantern slide projector, the enlarged particles boing measured with a ruler. Knowing tho entire enlargement (by actual (1) "Comparative Teats of Instruments for Determining Atmospheric Dusts*, Public Health Bulletin Ho. 14-1, Treasury Department, Washington, D.C. (!') "The Analysis of Silicate and Carbonate Kochs*, S.P. Hlllebrand, Bulletin 422 U.S. Geological Survey, Washington, D.C. (') "rulu.onnry Asbeotosls", W. . Coohc, British Medical Journal, December 3, -.:27. ----------------- A . -k 7- measurement), It was easy to calculate the original particle size.(5) By the use of Bacon's (6) logarithmic probability paper, the logarithm of the function to be measured - in this case microns - aro plotted as ordinates against the probability of occurrence as abscissae. Since the line is straight, exterpolation and interpolation of any desired region is facilitated. The analyses are reported in total particles per cubic foot and also / in the corresponding weight of the dust in milligrams. There is no indicated relationship between the dust oounts and the corresponding weights. Con sequently, the weights are not included in the tabulations in this report. Table Ho. 1 shows by plants and by departments the dust counts in million particles per cubic foot of air, The plants included are all in the United States and are mainly of a textile nature. Xt will be noted that the oounts in plant A are of particles 10 microns and under, while in the other plants all the particles were oounted. nevertheless, direct comparison is possible, as in no sample taken were the number of particles 10 microns and under less than 94 peroent of the whole, which makes it evident also that in regard to dust control we are oonoerned only with the smaller sl2es. Xt is also important to note that whereas the dust in the preparation room is practically all due to asbestos, the contrary is the oase in, the other departments. Xn tho carding, spinning and weaving rooms asbestos is about 25 per cent, of the material used. On special Jobs the percentage of asbestos may be (5) Orccn, II. "A Photomicrographic Uethod for the Determination of Particle Size of Paint and Rubbor Pigments", Journal ?ranklin Institute, 1921, 192, 637. (6) Whlpplo, O.C. - Vital Statistics, John Wiley k Sons, H.Y., 1925, p. 451. 2 DEFENDANTS maawr/- n -t 7 - 8n - j fi miHTCO *H A 1 I i tii < i i . I 20 to 70 50 to 82 of e ir per c u .ft. Taken por c u .ft. P a rtic le s Sanples P a rtic le s llilllo n No. M illio n 1 orH O ^ fol 4O* n o rH ~CM3 "iVo. "iHS ro: <>5 rt* Ol rH 4OJ 1 1 1 r*IOM r-l ocuO nC -h j i a-*V o 1 PLANT E PLANT D 91 O *3. s O H .X as Wa ta-i i o . *! ^, of a ir o IO 1 111 1!1 to * rr*tHoM' <o4* O M HBOo* 1 M to IO 1 I l1 c~ +o 1 1 H 11 rIOH 1 1 B cj~ p4P| iWrwi rn >a eCpl .2 +O> r3a-l qou -h>c <h C ,0 a 11 5$ t o 10 1 10 > *o HU M i .-'Sa CO 1 IO CD to i 1 1 No. M illio n Samples P a r tic le s Taken per c u .ft. of a ir Included In s p in n in g No. M illio n Samples P a r tic le s Taken per c u .ft. of a ir - CO (W# V H O n. o O 1 IO . HN <** > : at IO 1 >o 1 ca iur.ft.- i V.- 1 2 DEFENDANT'S L( r' EZXHJIBLIT ^. f - v(V..i if' M illio n 9) 4) o fH9a* QCi ^ SS S3 03 C^i C-* u 0> Q per of cw rH rH r*+ O *o> He* Csl HOH kO > in M N M roH oa t* c ) g c c q it T IQ M .5 4-> V) 3 c 1/5 to 1 | 1/20 to 2. 1/3 to 4 4 J 1/3 to 4 $ 51 IO > 1 1 4# 1 1 1 1 * to 1 il 1 H 0 -C po re p a ra tio n ard room 'e lt Dept. folded brake bend and clu tch -9- COinJITICITS III THE 7LAHTS The processes in these plants core very similar to ootton Bills in general. Tor illustration, the process in the preparation room of plant 5 is detailed at length: Asbestos is received in bags and these are emptied upon the floor and the asbestos is shoveled into pug mills and run for about five minutes in order to orush and open the fibres. Trom there the asbestos is shoveled into trueks and wheeled over to hoppers with either horizontal or vertical openers, similar to those used in the textile mills. After passing through the opener, the material is discharged into truoks. Vaste manufacturing material is first run through a garnet machine and discharged into trucks which are wheeled over to the openers and the matorlal is fed into these in the same manner as the new material. The material, after being discharged from the opener is put onto a vibrating or shaking screen where the long fibres are plckod off by a suction hood and blown into a bin to be used again in textiles. The short fibres falling through the soreen are either sold as such or used in making an asbestos oement. The ootton is reoeived in bales, opened, and also run through vertical openers. It is discharged into trucks. The filled trucks from the vertical and horizontal openers containing either the asbestos fibre, the cotton or the waste material are transported to separate storage bins. As needed, theso materials are weighed and dumped onto the floor in proportion to the mixture desired and the resulting mixed materials are then passed through M DEFENDANT'S '^EXHIBIT M nv h 0 DEFENDANT': EXHIBIT 10 - JZM V.' I a nixing picbor. As thio mixture la discharged from tho picker, it la sprayed with a light mineral oil. The material la then paased onto a meohonlcal oonveyor and token to the storage hin In tha card room. Two of these mixing pickera dloch&rgo onto this conveyor system, while a third machine is equipped with a suction device which conveys the material to a storage hin in the card room. The object of the two systems is to facilitate the handling of two grades of material at the soma time. This third aaohine is not equipped with on oil spray. The object of the oil spray is primarily to entrap the. small asbestos fibres and bold them enmeshed in the cotton fibre throughout the processes of carding, spinning, and weaving, Incidentally, it is apparent that it also diminishes the amount of dust. The material is saturated with about 4 per oent. of oil at this point, but by tho time it reaches the looms the oil has diminished to less than 1 per oent. Vhile mineral oil was used in the preparation room of plant C, it apparently was not as efficacious as in plant B. In plant 5 oil was not used, nor was there any attempt at humidification or any system of dust exhausting. Carding machines were fed by hand. Zn plant A there was a humidifying, ventil ating and heating system, while in plant B natural humidity sufficed for the process. In plant B the carding machines were equipped with a dust exhaust system, but it was not efficiently used. In plant C carding was done in two buildings, ono of which was equipped with an air conditioning system, and in both buildings the machines had exhaust equipment. Two plants, B and C, had artificial humidity installations in their spinning rooms. In the former the temperature was 76T., relative humidity 70 per cimt. One plant, C, had a humidification system in tho twisting department n . h i - 11 - : DEFENDANT'S EXHIBIT -ZlL and also In tbs. wcaviuc department whero the rclatlvo humidity was 76 por oent. with a dry bulb temperature of 69'T., as coraparod with a relative humidity of 44 per cent, is the weaving room of plant A. Aside from plant E, which was unnecessarily dusty, it would appear that the dust hazard was not excessive except in the preparation rooms of plants B and C. The dust counts are interesting too, when considered in the light of the permissible standard for siliceous dust, established by the United States Public Health Servloe," namely 10 million portiolss (10 microns and under) per oubic foot. However, we are not Justified in assuming that because asbestosis is a milder disease, clinically, than silioosis, the threshold of permissible dust counts is higher. Asbestosis is pathologically different from silioosis, and the experience so far does not warrant an attempt to define on arbitrary standard of dustiness. DUST COKTROL Various measuros, suoh as oiling, humidification, and local exhausts, tended to reduce the dust, nevertheless, it was evident that they were only partially sucoeesful. It also is apparent that, if it is expeoted to control dustlnoas in these plants, final relianoe must rest upon properly oonstruoted exhaust equipment. In plant C in one department an experimental installation was set up. In spite of some obvious faults, this equipment, on the basis of comparative dust counts, reduced the dust by 50 per cent, and with further alterations will probably be 75 per cent, effective. Por all praotioal purposes this is quite satisfactory. It is noithor practicable nor economically desirable t0 install such equipment as will make the air entirely dust free, even if this "Health of Korboro in Puaty Trades (Cranlto Industry", Public Hoalth Bulletin 'o. 187, U.S. Public Health Servloe, Washington, D.C., 1929. - 12 wore possible. The normal defensive mechanism of the body takes oare of a fair amount of atmospheric pollution. It is when the body io exposed to an excess* ivo amount of dust over a long period of time that this defense mechanism brooks down. The application of exhaust equipment to textile machinery involves considerable difficulty, especially where the construction of the plant is such that It is not possible to apply down draft suction to the looms. It is desirable to install exhaust apparatus in any plant on an experi mental basis first, and then check its efficiency by dust oounts. This practice will result in saving the needless expenditure of mush money. ^ PHYSICAL ECAimiATIOHS It was soon obvious that the diagnosis of asbestosis must rest mainly on I-ray films of the chest. As in the early stages of silicosis, the symptoms of the asbestos workers were usually indefinite and inconclusive. The follow ing tables are based on physical examination, together with X-ray films of 126 persons actually working in asbestos plants in the United States. Ho Canadian results are included here. These esuses were selected more or less at random from among those having more than three years of employment in the industry. The interpretations of these films all are based on the readings of one compe tent roentgonologist, but they have been studied by several others experienced in this fiold. The differences of opinion were of a minor nature, and there was general agreement to interpretation. The films were raod conservatively, the X-ray findings took into account the physical examination and the age of the individual, and only those were classed as positive about whloh there was 2 DEFENDANTS. ^EXHIBIT fesaaf 1 13 no major disagreement. All concerned wore guided by their experience in sili cosis and other types of pneumoconiosis, henoe the films classed as negativo i: for a3bestosifc wore further subdivided into "doubtful" and "negative". Only j time can tell whether the individuals classed as doubtful are progressing : toward a definite asbestosis. Particular attention was focussed on the presence j or absence of indications of tuberculosis and, in this respect, all the re viewers of these films were in aooord. With the unhappy experience of silioosis in mind, it was felt that a great deal of oare should be devoted to ascertaining, if possible, whether**or not asbestosis predisposes to tuberculous Infection. | Table II exhibits the diagnostic classification of these 126 individuals, with their symptoms and specific occupations. Pive of these per sons were not physioally examined. The cases of asbestosis are divided into two classes, first stage and second stage. The first stage embraces those who show by X-ray examination definite lung pathology sufficient in extent to warrant a diagnosis of pneumo coniosis, but who have no definite symptoms. The second stage oases exhibit more extensive lung pathology and also definite symptoms. All these individuals* were actively engaged in faotory work, and it was not praotioable to make any distinction between them on the basis of working ability or disability. Bad any individuals been found who exhibited extensive pulmonary I involvement and marked physical disability or total disability, they would have j beon classified as third stage, but no such were found, ! --------------------------------------------------------------------------------------------------------------------------------- I -no anbostoo worker (2nd degree stage) retired of his own accord and because of j uge ten years proviouo to this study, but is still aotive about his garden. I jj !!!HW L_T~ 2 DEFENDANT'S -- i ataeg&uw. ............. - 14 .. ........ "" --------- 1 It will .be ocon from Table II that of a total of 126 X-ray examina tion* four wero diagnosed a second dogree aohosto8iaj elxty-throe as first degree; thirty-nine as doubtful; and twenty aa negative. Table II also shows that only eight individuals out of sixty-four with positive asbestosis were entirely free of symptoms, while ten out of thirty-seven with doubtful and seven out of twenty with negative diagnoses were free of symptoms. Dyspnoea and cough were the symptoms most complained of, but none of these cases exhibited the urgent or evident typo of 'short wind* seen in true silicosis. Several of those olacaed ae negative stated that they were "short-winded* and were so recorded, but too much emphasis should not be plaoed on these statements of subjective symptoms. Table III shows the occurrence of dyspnoea and cough.* TABLE III Positive Doubtful Negative Dyspnoea Cough Not examined Total 40 16 6 39 0 10 320 67 39 20 The inoidence of tuberculos is (based upon X-ray films) as revealed in Table TV is both interesting and important. TABLE IV Positive Doubtful Negative Tuberculosis (healed) Tuberculosis (active) Total Examined 7 1** 67 1 0 39 2 1 20 *ln Tables III to XI, inclusive, the divicion into positive, doubtful, and negative rcforo to tho caroo bo classified in Table II. Thiu case who diagnosod ao probably active on the X-ray findings. DEFENDANT'S - 15 - During the progress of the study, physicians who were practicing in the communities where aahe3tcs workers lived were questioned, and stated that they did not find on unusual amount of tuberculosis among there workers. The contrast between this state of affaire and that found in communities with a silicosis hazard, is noteworthy. The following tables classify results of examinations by occupation in industry and by years of exposure. It is to be remembered, however, that these individuals are classified according to the department in which they were working at the time of examination or where they had spent most of their time, liany had changed from one department to another and from one plant to another during their years of employment in the asbestos industry. Since only the amounts of dust oolleoted at the time of this survey in the various in the atmosphere inhaled by these people over the years of their employment. Consequently, it is not possible to oorrelate individual cases with definite amounts of dust exposure. TABLE V Weaving Carding Spinning Warping Spooling Trucking Loom fixing Packing Winding Picker Twieting Other Total examined L Tositlve 22 13 9 1 3 1 3 1 3 3 6 67 Doubtful 13 4 3 0 5 1 1 0 4 0 5 3 39 Begatlve 6 1 3 2 2 0 0 0 1 2 0 4 20 r\ . i * a x 11 (k o u Pi* i * i _r ? ? " = a : i i ,x z ij ,x 7i i* s i lit .c jt i ^ its 'C 3 ass 2 t i- V3 *si* s?*r- i *i * i : 33 t: ii % 5 f 0 7 l f2 J irf. X i- k. HU i IE I! ti A lts *r xs I =* fr 51 i S fI t7 73 <rt * 0 5*> *i r6 i *: i: I j 6 I 5E <* 11 iI * (r1I X A X ir I3 3l i i = i A1 .t s:* X i* Elf I 7 ?E r ;7 x -- ti if r1 fr At ' i r4 5I It if 7f x -x S* *t i f3wi- il ? i Hi V7 M3 ll st 0m :I ta 6 00 - r* 7l 0 l si 1t !I X' E : E M* *; r: *t I: iii Et t f tii E U ii E x It El?6 : : xt H l? 17 B 8? :e 7 7r t I 7s r ri j : x? w :j : ! s li a r. iJ r t c A a j i a ; I s : i r? 5 f-*1 1 3t:5 rS t i l. 75 :i a: v3 i t . fj 0 0 0 MW * It W f * r mU V w 9 : c 3 : *l ; : r :! 0 0 sc w3 t n 1 lz : 0k 7j : r3 0 1 I 73 5 75 i iJ *1' iI = -5 * r R * * J 73 I - r12 *?1 r^*0i 0 * * * *i ? 2 3 a .: XM ^ 4 E ! ! ! ! II I * ^i : DEFENDANT'S ^ /\ i ' ry U to (ft - to w if*a r. ftto fa fa z fa u fiai tfao ii tft rt c3> 1 Ai rrt fa At <a% v p 5 a1 t a Iaf 5 .* l a a i H to ft na to* ia. a* au Ma l' a to a to a i. ta* iat 7 1 a a fpt. <a ft p tit a 2a * - w Xto to* m fa 4 ** - a* Vft to * 5 m mc = 0 0 rt R r B BB V K Vfa * * - t* V b s s M #to w r> fa o Vt ft* rfS O1> A " sh = ft 1 tfot 3 ft l tAo t Ir 1 i` 1 =5 s l t w3 e . I Sf 2 ic A 1 2 l i 1 xw rfa r a I a x H a9 2 t i A X fi i ur m 4 * i p r L 1 2 xs 1 2 xX efa m3 a em 1 2 I .? r .r a 4 ? i : i l A* L ! H X. f: f5 1 1 2 x z % ft l 7i 2. Z Al Wftr - aI a' i 4 .F =' Xa 7, z ^ fa - * * r. r% at a = K to Vto f*ai S3 t ft 22 ll s a. a tlo JF r. -- t. s. t a to i* ll t: x: ; 7. Jl vt ? A * 3r a i faa ito iat x 4 * F f r, tl . r ii i ?t f te. r :i ii p t r i l mm - w to w to to - fa to* N fa Xa l l ta a ft aa aa aa F l ta a fa a a fa aa to t p r fa f a aa a a to t fa aP to a r a 9 1 ila ca 9 1 a a 3 1? to< a i 1 a t j a aa -* 9 to a t a r a * 3 ftao tfast i sa tfoa z ftao a aa aa f 9 iI a ii fa a p Ato 5 ia * a :v 9 { r < r a i afa' fa- fato aa nto i a fa m ...i .? to 5i J a a a a* t 3J t. fa a a fa 3 a m to 3" a rw 0 a a ai r a r ma ai to * a to a aa r 5 a a a * a a J a fa aj ft> aA 11 a it a a 3 1> 2 2aa a a F 3 a a S a >' aa* a a a a fa a 5 5 t J 1 i* s to 1 V :; 1 : r' ato a. vV * i i 1 1 i t (i ft t 11 1! | t? a t if ;* :? i m e| r & a a : 1c *fa--a C rt fa to a fa a i 9 to ft ! a ft V faw aa rt r a 37 ti fa a w ** ii a 3 fa a ft 9 i * to i t 1 a to vto !! 5fa a ru p H i, l ft I L Ft- 1 Ec p | a > 39 It rs t 9 i t a aa 'l i ft a c 5T a ia if a a a ? t w fa a a V r ft a a a i r 9 < i P9 | t to It va i a a Ia to WW 'ttfooa a a ft to ato ** a | a : if a a ft I ( f a a; ^*1 to . .. a > a vs!:i * . 1 < ta fa a . a i' i to. ftto* a t a a " ft: i 0 w 1 * a a a ' *a ri! ft ai a a a 'i a \ f:  `ml K U Im m u */ * m ** r k i xz & 5E (> M u u t* * uc * t: sr i T J T it - DEFENDANT'S ^exhibit mx DEFENDANT'S EXHIBIT f; *'FY ' :*! u ii * tx p? # * A* X *4 ? X n* n i* n a X 41 A 9 .? krm i> aV r n <7 * * ki * M * m Wsk* 13 o M M* ** * Ei I! rv m m t m \. xa s? gI c ?iE* I S IN;itr I 1 fl ? i 3X 1aw I cE E X A i X I ? * ' * l * l * r p t E : x#* * t E & *mt A X w l I C g wr A i 4 2 4 l x i* Am i XX t: i :i t X. A r x - t= P ft i It X 1X r? rf F > I I XX i p. Fr x t i i m^ l* II - * rfl n I n* t r* 4 X 0 A* M i 5XV is ;: ak -AA u T` J-.r* :-:a: *!: r.s f* ! ik Ssr * *a0 a U i. *g *0 g N f: w 0 r ! i7 t 7 13 rs mm p s i- xi 0m m n A m a: 7x a }! x; ra --* . #X. * f. x 1* r*1 : s 5r ?. i Ai I! o i; * o O ^ It s r. * L W rt --J t 9 n- t C * - 7! -j i s##: s ? pn r * ii ~ m s 4 u?11**!! ^ J * 4> 4* * Z .* JJ" M * x r. r x sir iii i : t : : r fft r jV frB s * rr=1 ; S '= r * 5 : S % rr "w ll * 9 *E r ii1 JiF S ?f J l J 'r * i" 1 ti at- 0* i *^ Tj * 1 i if ZX i' lJ jr i 14 W # *4 N m xi t t! 5| i i"*>* k-* **f Wk ^* "* 4# s s t t n ** * > r ; f i ' : * i i+ i+ m >M. :4i s X# 7 T 3 5 ft 1 J. I z 1 n i ! *i5 I 7 i It ill il t :e 1I f!*f6E Ilf t a ms0?w0. X- Al f .i *s: i-I ri i"i f2 a ff , .X s ^c 9 9 .? f ,? - i E . ff L i i i z *i 1* si i -^ <t3 5 sc * 1* i: 53 r ?* Z ft\ rl 3r tE i 4i s ff =f .-Sx. Si6? I Ii I! t 5L if 3 Ii ii iii ii iii rIff i IE I if *s s i*S I lIl js; s 9 9I i I' e t m I* n v t> ? l: l fli|t| Si f ? 5 iT o -- W9 ^ :IT W? ft ? * a > tri j5 m mt?< v |? * i iv m I i :o :t IrZ -* w it l ft M 1 i : .* j ? *7 3 .*T> Pt A ia3a : t: i? ; DEFENDANT'S jiS 01/so  Over 15 years 10 to 15 years 5 to 10 years Under 5 years Total examined TABLE VI Years of Exposure Positive 13 7 30 17 67 Doubtful negative llpart time) 3 32 27 3 11 12 39 20 (1 not eontinuous) The following tables are also of Interest, but, like the two previous, are of limited, value and little in the way of definite oonclusions can be based upon them. TABLE VII Age Groups 50 and over 40 to 49 30 to 39 20 to 29 Under 20 years Total examined Positive 12 13 17 24 1 67 Doubtful 3 6 12 16 2 39 negative 4 6 8 0 20 TABLE VIII Sex Positive Hale (Total examined 108) Temale ( " IS) 59 8 TABLE IX Doubtful 32 .7 negative 17 3 Chest Expansion Positive 1 to 2 inches 2 to 3 inches 3 inches plus Kot cxaclned I- ___________________________ DEFENDANT'S-1 .EXHIBIT <r| 28 31 5 3 Doubtful 13 21 3 2 39 negative 7 12 1 0 20 - 17 - TABLE X Chest Pindlr.Ts Physical signs of chest trouble Do physical signs Not examined Total Poaltivo 33* 31 3 67 Doubtful 9" 28 2 39 Negative # 13 0 20 That significance, if any, can he attached to the presence of asbestos oorns* on the hands of workers appears doubtful, as Indicated in Table XI: TABLE XT Positive Doubtful Begative Asbestos oorns Not examined 12 7 2 3 20 Saoh roentgenologist who reviewed the X-ray films called attention to the fact that these films indicated a very unusual incidence of enlargement of the heart. It is probable that this is a compensatory enlargement due to the additional -work put upon the heart in efforts to pump blood through the fibrosed lungs. In the first silioosis studies, published in this country in 1917,**** Dr. S.B. Chlldn of Denver, who interpreted the X-ray plates of this study, commented as follows: The heart in miners' consumption (silicosis) easts a larger shadow than normal and in the early stages is probably caused by its increased musculature. The shadow of the heart remains larger than normal in the second and also in the third stage." At least six of these showed no evidence associated with asbestor.is. **Two cf these not associated with usual signs found with asbootosis. ***Slx of these not associated with ususl signs of asbestosiB. ..............Klners' Consumption", U.S. Public Health Service Bulletin #85, January, 1917. DEFENDANT'S EXHIBIT. n - 18 It Is pccr.ible that not sufficient attention ban been paid to the effects of the pneumoconioses upon the heart. IKSURA37CE CLAIMS In the effort to thro? any possible light on the relationship between asbestosis and pulmonary tuberculosis, an analysis of death claims and total and permanent disability claims was mads in regard to those companies carrying Oroup insurance and where the figures wore available. There were 2099 lives involved for a total exposure of 7019 life years. The death claims are so small*~ijTnumber that reliable conclusions can not be arrived at from any subdivision of the figures. The same is true of the slchness claims under health insurance., the number of-claims for respir atory diseases la high in two of the plants studied but low for the others, based upon the Metropolitan experience of 1927. however, during the latter part of 1928 and the first part of 1929 there was an epidemic of influenza. ---------(^/ The records of one establishment (plant B) showed that six of thirty-six death claims and eight of ten permanent and total disability claims were listed as due to pulmonary tuberculosis. This appeared to be an Inordinate amount of tuberculosis from this plant, however, many of the employees were Negroes and also tuberculosis olalms are generally high in this seotion of the country. Realizing the diffioulty in diagnosing pneumoconiosis and the tendency to confuse it with tuberculosis, these claims were studied individually. The physicians who had treated the individuals wero interviewed, and hospital and sanatorium records, including available X-ray films, were investigated with the following results. 2 DEFENDANT'S ` 0 2:54 - 19 - Tenth claims: 1. Proved to bo a typist, not exposed to duet; died of pulmonary and intestinal tuberculosis. 2. Colored male age 27; worked in asbestos one year and eight months; died of pulmonary tuberculcsic following a hemorrhage; was in sanatorium ten months. Also had a four- ' pluo C&sserunn. Ho evidence of asbeatosls. 3. Colored male age 32; worked in asbestos plant one year and seven months; died of pulmonary tuberculosis after one month In hospital. Cavitation both lungs; no evidence of asbeitosls. 4. Colored male age 34; worked in asbestos plant two years, and six months. His physician believes this was a case of un complicated tuberculcEis. tan not Innate of hospital or sanatorium. flo information could be obtained of the other two cases except from the death certificates which gave pulmonary tuberculosis as the eauje of death. Total and permanent disability claims: 1. Halo, employed in asbestos plant three yeare. Hie physician states he first came under his observation with an old established case of tuberculosis about two years after asbestos employment started. Aleo had tuberculosie of the kidney and cervical glands. 2. liale, employed in asbestos plant eight months. EIb physician states old fibroid tuberculosis with tubercle bacilli in sputum. Ho X-ray available, but according to physician asbestos bodies were found in sputum. 3. liale, ten years employment. Two physicians who treated him at different times are now Inclined to believe this man is not tuberculous, but has aBbestosis. 4. White male, was re-examined at timo of investigation. Eia physician reports well nourished, husky looking, good color, no cyanosis; no clubbing of fingers, diminished expansion, incossnnt cough; X-ray chows fine mottling disseminated through both lungs. No evidence of tuberculosis. Probably a seoond stage aabestosls. DEFENDANT'S 21 4. Acbeatosis as obscrvod in this series of cases does not eause any marked decree of disability. However, it is possible for unconplic&ted osbestosl3 to result fatally. 5. It is not known how much asbestosls say add to the mortality of pneuaonia and acuto pulmonary infections other than tuberculosis. 6. It is not practicable as yet to establish standards for the dust content of air and in view of the aony low dust counts in this report, oompared with the U.S. Public Health Service standard for silica dust, it is possible that asbestos may cause pneumoconiosis more readily than free silica (S102). 7. The amount of dust in the air in the asbestos plants studied can be sub stantially reduced. RECOITISTOATIONS 1. That the Industry seriously face the problem of dust control in asbestos plants. 2. That new employees be examined physically and rejected for employment if they Bhow tuberculosis or pneumoconiosis. 3. That employees be examined physically every year or certainly every two years, this examination to Include on X-ray examination of the chest. 4. That the industry sponsor studies on known cases of asbestosls, as well as studies on effects of asbestosls on the heart and circulation. 2 DEFENDANT'S ; i m1e5xh1ibii%^B n n c rr 20 5. Uhitc nale, thirteen yearn in asbestos plant. Is now in sanatorium. An interesting case. Uis phyaiei&n states be bt.u extensive asbeitosis and pulmonary tuberculosis; cavity in right lung; sputum loaded with tubercle bacilli and asbostes bodloc; believes tubercu losis long antedated aebestosis. This patient is progress ing in a satisfactory manner. It was not possible to looate the other three cases of total and perm anent disability who hid been diagnosed as having pulmonary tuberculosis.. On the basis of the information obtained the death claime appear to be due to uncomplicated tuDerculosls; three of them were Negroes. It vae more than probable that these men were tuberculous at the time their employment in the asbestos plant commenced. Of the eight disability claim oases, one was unoomplic&ted tubercu losis and two were uncomplicated aebestosis who were put on disability because of a mistaken diagnosis of tuberculosis. In this same community we know of one death duo to uncomplicated asbestosis in an individual with many years employment in the industry.* CONCLUSIONS 1. Prolonged exposure to asbestos dust causes a pulmonary fibrosis of a definite type distinct from silioosis demonstrable on X-ray films. Clinio&Uy, it is of a type milder than silioosis. % 2. There is associated with aebestosis in a large percentage of eases definite cardiao enlargement. 3. Asbestoeic does not involve an unusual tendency to pulmonary tuberculosis. Personal communication. Details not yet published. DEFENDANT'S ^EXHIBIT m o i : 5 e - 21 i 4. Acbcctosis r.a obscrvod in this series of cr.sea does not cause any Barbed iogree of disability. However, it is possible for unconplic&ted asbestosis to result fatally. 5. It is not hnown how muoh asbestosis say add to the mortality of pneuaonia r.nd acute pulmonary infections other than tuberculosis. 6. It is not practicable as yet to establish standards for the dust content of air and in view of the many low dust oounts in this report, oompared with the U.S. Public Health Service standard for silica dust, it is possible that asbestos may cause pneumoconiosis sore readily than free silica (S102). 7. The amount of dust in the air in the asbestos plants studied con be sub stantially reducod. RECCES SEDATIONS 1. That the Industry seriously face the problem of dust control in asbestos plants. . That new employees be examined physically and rejected for employment if they show tuberculosis or pneumoconiosis. 3. That employees be examined physically every year or certainly every two years, this examination to Include an X-ray examination of the chest. 4. That the industry sponsor studies on knonn cases of asbestosis, as well as studies on effects of asbestosis on the heart and circulation. n-17^7